Correspondence  |   November 2016
In Reply
Author Notes
  • Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié–Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Université, Paris, France (A.M.). antoine.monsel@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
  • (Accepted for publication August 8, 2016.)
    (Accepted for publication August 8, 2016.)×
Article Information
Correspondence
Correspondence   |   November 2016
In Reply
Anesthesiology 11 2016, Vol.125, 1076-1077. doi:10.1097/ALN.0000000000001339
Anesthesiology 11 2016, Vol.125, 1076-1077. doi:10.1097/ALN.0000000000001339
We appreciate the interest of Rouzé et al. in our recent article on the role played by tapered-cuff endotracheal tube in preventing early postoperative pneumonia and microaspiration after major vascular surgery.1 
We are aware of the pioneering work by Nseir and colleagues3,4 suggesting that sealing properties of endotracheal tube cuffs might be enhanced by the tapered-shape design. We agree that the ongoing randomized controlled multicenter BestCuff study,2  carried out by the same team, will be essential to fully evaluate the efficacy of tapered cuffs to prevent microaspiration. However, two major differences with our work deserve to be highlighted. First, their previous prospective study3,4  compared tapered versus cylindrical cuff made of polyurethane and not polyvinyl chloride. Second, both previous studies were carried out in a medical intensive care unit enrolling patients with median mechanical ventilation for more than 15 days. In our clinical controlled randomized Tapered Endotracheal Tube to prevent Respiratory Infections (TETRIS) trial, the median duration of mechanical ventilation was lower than 30 h in patients exclusively enrolled after major vascular surgery. In other words, they properly designed studies mainly focusing on ventilator-associated pneumonia, while we designed ours focus on early postoperative pneumonia. This divergence in the primary endpoint of our respective research may have yielded different results in terms of the impact of tapered-shape cuff on microaspiration or pneumonia rate.
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