Correspondence  |   November 2016
Is Tapered-cuff Shape a Risk Factor for Overinflation of Tracheal Cuff?
Author Notes
  • CHU Lille, Critical Care Center, and Lille University, Medicine School, Lille, France (S.N.). s-nseir@chru-lille.fr
  • (Accepted for publication August 8, 2016.)
    (Accepted for publication August 8, 2016.)×
Article Information
Correspondence
Correspondence   |   November 2016
Is Tapered-cuff Shape a Risk Factor for Overinflation of Tracheal Cuff?
Anesthesiology 11 2016, Vol.125, 1075-1076. doi:10.1097/ALN.0000000000001338
Anesthesiology 11 2016, Vol.125, 1075-1076. doi:10.1097/ALN.0000000000001338
We read with interest the study by Monsel et al.1  on the relationship between tapered-cuff tracheal tube and early postoperative pneumonia. The authors should be congratulated for the excellent work they did.
They found no significant difference in the postoperative pneumonia rate or in the microaspiration of gastric contents and oropharyngeal secretions between patients intubated with tapered tracheal tubes and those intubated with standard tracheal tubes. They recorded cuff pressure (Pcuff) for 5 h and reported that the percentage of time spent with overinflation of tracheal cuff (Pcuff more than 30 cm H2O) was significantly higher in the tapered compared with the standard groups. They suggested that the higher variations in Pcuff might have been related to the tapered-cuff shape and could explain the negative results of their study. However, in our opinion, the cause-to-effect relationship between the tapered-cuff shape and overinflation of the tracheal cuff is unlikely. First, the percentage of time spent with underinflation was low and not significantly different between the two groups, which is against this hypothesis. Second, Pcuff is tightly correlated to airway pressure (Paw). Therefore, no valuable conclusion could be drawn without information on Paw in the two study groups. The significantly higher positive end-expiratory pressure reported in the tapered compared with the standard groups suggests that Paw might have been also higher in the intervention group. Have the authors recorded Paw during Pcuff recording? If not, could they at least provide the data usually recorded by nurses every 2 to 4 h regarding Paw?
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