How the Kimberly-Clark* Microcuff* Endotracheal tube may help reduce the device-related risk factors of ventilator-associated pneumonia (VAP).

Kathleen Stoessel: As a registered nurse for over 35 years, I’ve seen the severe consequences of hospital acquired pneumonia [HAP] in our most vulnerable patients. Moreover, my experience as a clinical educator has given me an even greater appreciation for the cost of HAP as it relates to lives and dollars. In the United States alone, a hospital-acquired pneumonia typically increases the cost of care by as much as $40,000 dollars per episode, with an estimate of over 1.2 billion dollars per year in cost for the U.S. healthcare system. Additionally, ventilator-associated pneumonia [VAP] is a type of hospital-acquired pneumonia that is especially costly. Patients with VAP have longer lengths of stay in the hospital averaging 7-9 additional days, and the mortality rate attributable to VAP may be as high as 70%. Due to the severity of this infectious disease, it is imperative that healthcare professionals have prevention strategies in place that reduce its occurrence.

There are many known risk factors that are associated with the development of VAP. Some of these risk factors are unique to the individual patient and may include extremes of age, compromised immune system, and severe underlying conditions. These risk factors are largely out of our control. However, other risk factors, including supine position, lack of consistent, comprehensive oral care, and the presence of an endotracheal tube [ET tube] may be controlled by implementing proven risk reduction strategies.

There are two main complications associated with ET tubes that increase the risk of VAP: tracheal trauma and micro-aspiration. Tracheal injuries can occur when an over-inflated cuff places too much pressure on the trachea, which may result in ischemia, necrosis, and infection. Alternately, an under-inflated or asymmetrical cuff can rub against the trachea, causing ulcerations and other complications, such as the development of scar tissue. Another complication, micro-aspiration, occurs when a cuff creases or folds, creating channels that allow pooled contaminated secretions to leak past the cuff directly into the lungs.

The perfect cuff would avoid these two complications by distributing pressure evenly, allowing manipulation of the ET tube without disrupting the seal or rubbing against the trachea, and preventing the tip from angling toward the tracheal wall. Additionally, the ET tube would be strong enough to prevent rupture by suction devices and be able to hold air pressure over an extended period of time. It would also be thin and pliable enough to avoid creases that form channels through which microorganisms could pass. Finally, it would also conform well to the tracheal wall while sustaining pressure over an extended contact area.

Due to the severity of VAP, it is imperative that healthcare personnel become knowledgable of the risk factors associated with its development. Patients who are supported by a mechanical ventilator are especially at risk for pneumonia as their normal host defenses and clearance mechanisms are disrupted by the endotracheal tube. Establishing and following effective prevention strategies are essential in reducing the occurrence of VAP. One essential prevention strategy is the appropriate selection and use of endotracheal tubes.

D. Theron Van Hooser: As a former respiratory therapist currently working with the team at Kimberly-Clark, I am excited about the potential the Microcuff tube has to improve patients’ lives. I have always felt that we needed a tube that comes closer to the ideal Kathleen described above--one that seals better, molds into tracheal grooves without gaps, seals at low pressure, and of course reduces micro-aspirations and tracheal injury.

The secret that makes Microcuff an impressive ET tube compared to conventional PVC tubes is the microthin polyurethane material used in the cuff. This advanced microthin polyurethane material is both thinner (10 microns vs. 50 - 80 for conventional cuffs) and stronger than conventional cuffs (twice the puncture resistance). In addition, the cuff’s cylindrical shape is more anatomically correct and designed for increased protection against micro-aspiration. The microthin material is also able to conform better to the tracheal anatomy with a lower cuff pressure than conventional PVC tubes.

The main benefit, of course, is the seal. Conventional cuffs create folds and channels when inflated, which may allow fluid to leak past the cuff and into the lungs. The microthin polyurethane material minimizes those channel openings, reducing the possibility of micro-aspiration of contaminants. In addition, the microthin material allows greater visualization of the vocal cords when the cuff is deflated.

Because VAP is such a major concern for artificially ventilated patients, Kimberly-Clark is also working on other solutions. Meanwhile, pulmonolgists, anesthesiologists, and other respiratory care practitioners can be confident that with the Kimberly-Clark* Microcuff* Endotracheal Tube, they have chosen a tube that may help their ventilated patients avoid a potentially dangerous VAP.