American Journal of Roentgenology, Vol 163, 1333-1337, Copyright © 1994 by American Roentgen Ray Society

ARTICLES

Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients

R Greene, S Thompson, HS Jantsch, R Teplick, DJ Cullen, EM Greene, GJ Whitman, CA Hulka and HJ Llewellyn
Department of Radiology, Massachusetts General Hospital, Boston 02114.

OBJECTIVE. Mechanical ventilation is thought to increase the risk of nosocomial pneumonia by permitting leakage of bacteria-laden gastro- oropharyngeal secretions into the upper airways. The goal of this study was (a) to validate radiographic signs of pooled secretions above endotracheal-tube cuffs (supracuff liquid) in an animal model and (b) to determine whether suctionable pooled supracuff liquid can be identified on bedside radiographs of intubated patients. MATERIALS AND METHODS. Diagnostic criteria for supracuff liquid were initially validated by three radiologists interpreting 162 randomized radiographs made in an intubated sheep cadaver. The primary criteria included (a) replacement of the normal supracuff lucency with liquid opacity and (b) the formation of a sharp interface between the lucency of the upper edge of the cuff below and the liquid above. Graded infusions of 0, 3, 8, 13, and 23 ml of saline were made in triplicate into the space above the cuff, and radiographs were evaluated for the presence or absence of saline. The validated diagnostic criteria were used by two radiologists to estimate the frequency with which pooled liquid was seen on portable chest radiographs of 47 patients undergoing elective short-term postanesthetic mechanical ventilation. RESULTS. In the sheep-cadaver model, the diagnostic criteria for supracuff liquid allowed successful differentiation between no liquid, a small amount of liquid (3-8 ml), and a large amount of liquid (13-23 ml; c2, p < .0001). In a clinical study, radiographic signs of supracuff liquid were identified in 57% of 47 patients. In a small subset of patients (n = 18), the estimated liquid volume (mean +/- SEM) was calculated to be 7.8 +/- 1.1 ml (range = 2.1-18.4 ml). CONCLUSIONS. Radiography is a sensitive means of identifying small volumes of supracuff liquid above the inflated cuffs of endotracheal tubes. Potentially contaminating liquid pooled above the cuff of an endotracheal tube can be identified in about half of patients undergoing short-term mechanical ventilation. Our results suggest the suction of the supracuff space may be a reasonable prophylactic maneuver against nosocomial pneumonia. A much larger study is suggested to investigate the actual relation between pooled supracuff liquid and the development of nosocomial pneumonia.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. L. Munro, M. J. Grap, D. J. Jones, D. K. McClish, and C. N. Sessler Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults Am. J. Crit. Care., September 1, 2009; 18(5): 428 - 437. [Abstract] [Full Text] [PDF]

				E. Bouza, M. J. Perez, P. Munoz, C. Rincon, J. M. Barrio, and J. Hortal Continuous Aspiration of Subglottic Secretions in the Prevention of Ventilator-Associated Pneumonia in the Postoperative Period of Major Heart Surgery Chest, November 1, 2008; 134(5): 938 - 946. [Abstract] [Full Text] [PDF]

				C. L. Munro, M. J. Grap, R.K. Elswick Jr, J. McKinney, C. N. Sessler, and R. S. Hummel III Oral health status and development of ventilator-associated pneumonia: a descriptive study. Am. J. Crit. Care., September 1, 2006; 15(5): 453 - 460. [Abstract] [Full Text] [PDF]

				C. L. Munro, M. J. Grap, R. Jablonski, and A. Boyle Oral health measurement in nursing research: state of the science. Biol Res Nurs, July 1, 2006; 8(1): 35 - 42. [Abstract] [PDF]

				G. Chaiban, H. Hanna, T. Dvorak, and I. Raad A rapid method of impregnating endotracheal tubes and urinary catheters with gendine: a novel antiseptic agent J. Antimicrob. Chemother., January 1, 2005; 55(1): 51 - 56. [Abstract] [Full Text] [PDF]

				C. L. Munro and M. J. Grap Oral Health and Care in the Intensive Care Unit: State of the Science Am. J. Crit. Care., January 1, 2004; 13(1): 25 - 34. [Abstract] [Full Text] [PDF]

				B. Trotman-Dickenson Radiology in the Intensive Care Unit (Part I) J Intensive Care Med, July 1, 2003; 18(4): 198 - 210. [Abstract] [PDF]

				K. Smulders, H. van der Hoeven, I. Weers-Pothoff, and C. Vandenbroucke-Grauls A Randomized Clinical Trial of Intermittent Subglottic Secretion Drainage in Patients Receiving Mechanical Ventilation Chest, March 1, 2002; 121(3): 858 - 862. [Abstract] [Full Text] [PDF]

				P. V. O'Neal, N. Brown, and C. Munro Physiologic Factors Contributing to a Transition in Oral Immunity among Mechanically Ventilated Adults Biol Res Nurs, January 1, 2002; 3(3): 132 - 139. [Abstract] [PDF]

				M. J. Garfield and R. M. Howard-Griffin Non-invasive positive pressure ventilation for severe thoracic trauma Br. J. Anaesth., November 1, 2000; 85(5): 788 - 790. [Abstract] [Full Text] [PDF]

				M. H. Kollef, N. J. Skubas, and T. M. Sundt A Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery Patients Chest, November 1, 1999; 116(5): 1339 - 1346. [Abstract] [Full Text] [PDF]