Helping patients breathe easier

EHM talks to Douglas Hansell about the latest in ventilation and microaspiration.

Could you please describe your product(s) and its unique features.

Douglas Hansell. Covidien, a leading global healthcare products company and recognized innovator in mechanical ventilation and respiratory care devices, delivers reliable, indispensable respiratory care products for use in hospitals, healthcare facilities and homes. The company's integrated portfolio of respiratory and monitoring products spans broadly across pulse oximetry, airway and temperature management, critical care accessories, acute care and home ventilators and hospital software solutions.

In the pulse oximetry category, Covidien created the first commercially viable pulse oximeter more than 20 years ago; we continue to lead the way in R&D today with the Nellcor OxiMax n-600x pulse oximeter with Alarm Management System, which helps clinicians more effectively and monitors a broad range of patients. Launched in late 2009, Covidien's Mallinckrodt TaperGuard line of endotracheal tubes introduced a revolutionary, tapered-cuff design that significantly reduces microaspiration - a term that refers to the dangerous seepage of foreign material past the tracheal cuff and into the respiratory tract.

Tell us about the latest advances in the area your product serves.

DH. Microaspiration - the movement of secretions into the respiratory tract - is widely viewed as a cause of specific post-intubation pulmonary complications, including postoperative and ventilator-associated pneumonias. The overwhelming majority of such microaspiration cases stem from inadequately designed tracheal cuffs that fail to seal the tracheal passageway.

The current standard endotracheal tube, which has a barrel-shaped high volume, low-pressure cuff, was originally introduced in the mid-1970s as a redesign of the original red rubber tube. Though the gold standard for over 30 years, the barrel-shaped cuff provided an adequate air seal but did not adequately seal the patient's tracheal passageway. This allowed secretions to potentially migrate through folds in the cuff. Although these air seal gaps are very small - micro in size - they can allow gastric laden secretions or virulent secretions associated with pneumonia to enter into and be dispersed throughout the lungs.

The new Mallinckrodt TaperGuard line of endotracheal tubes reduce microaspiration by an average of 90 percent compared to conventional high volume low pressure cuffed endotracheal tubes. When used in surgical procedures and critical care applications, TaperGuard endotracheal tubes will substantially reduce specific and severe risks related to the movement of secretions beyond the tube's sealing cuff, most notably from pneumonia. In addition to microaspiration reduction, the Mallinckrodt TaperGuard^TM Evac endotracheal tube has been shown to reduce significantly VAP.

As a further example of the value of Covidien's integrated respiratory product portfolio, when the TaperGuard Evac endotracheal tube is used in conjunction with a Puritan Bennett^TM 840 ventilator, clinicians can further reduce the risk of infection because of the ventilator's inspiratory and expiratory filters. These filters prevent the ventilators from becoming either inspiratory or expiratory transmission vectors for viral and bacterial agents.

Discuss the educational services you offer for use of your product

DH. Covidien offers an exceptional level of service and technical support, including onsite and real-time training for clinicians. This hands-on service is complemented by a comprehensive array of clinical education resources, including a wide variety of free, accredited continuing education courses for registered nurses and respiratory therapists. Available through Covidien's Center for Clinical Excellence website, these self-paced courses can be accessed 24/7 and offer convenient post-testing, plus the ability to earn a Certificate of Completion that may be used to meet or accumulate contact hour requirements for re-licensure.

What new technology do you see as having the greatest impact on your area of expertise?

DH. Technology gains with miniaturization are likely to have the greatest impact in the area of portable ventilation. The ability to produce smaller ventilators addresses a key healthcare concern facing clinicians and patients today: How do we make a significant improvement in a ventilation-dependent patient's quality of life and health outcome? The answer in part depends on the size of the ventilator. Covidien offers the Puritan Bennett^TM 540 ventilator that weighs less than ten pounds and provide up to ten hours of portable operation. These improvements potentially provide ventilation-dependent patients - including adult and pediatric patients - the chance to live much less restrictive lives than would be possible with larger and more cumbersome equipment.

Biography

Douglas M. Hansell, MD, MPH, is Medical Director for Covidien. A Harvard-based physician, Hansell has over 20 years of multi-sector healthcare experience. In addition, Hansell has maintained an active clinical practice in Anesthesiology at Massachusetts General Hospital in Boston and has held teaching appointments at Harvard University. Hansell is board certified in Internal Medicine and Anesthesiology, fellowship trained in cardiovascular anesthesia and experienced in critical care medicine.