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Implementation of the TaperGuard™ endotracheal tube in an unselected surgical population to reduce postoperative pneumonia.

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Date
2020-08
Authors
Martini, Ross P
Yanez, N David
Treggiari, Miriam M
Tekkali, Praveen
Soelberg, Cobin
Aziz, Michael F
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Abstract
<h4>Background</h4>Endotracheal tube (ETT) designs to decrease the risk of ventilator associated pneumonia (VAP) include supraglottic suctioning, and/or modifications of the cuff shape. The TaperGuard™ ETT has a tapered, polyvinylchloride cuff designed to reduce microaspiration around channels that form with a standard barrel-shaped cuff. We compared risk of postoperative pneumonia using the TaperGuard™ ETT and the standard ETT in surgical patients requiring general anesthesia with endotracheal intubation.<h4>Methods</h4>We used an interrupted time-series design to compare endotracheal intubation using the TaperGuard™ ETT (intervention cohort), and a historic cohort using the standard ETT (baseline cohort), among surgical patients requiring hospital admission. We compared the incidence of postoperative pneumonia in the intervention and baseline cohorts. Data were collected from the electronic health record and linked to patient-level data from National Surgical Quality Improvement Project. Additionally, we performed secondary analyses in a subgroup of patients at high risk of postoperative pneumonia.<h4>Results</h4>15,388 subjects were included; 6351 in the intervention cohort and 9037 in the baseline cohort. There was no significant difference in the incidence of postoperative pneumonia between the intervention cohort (1.62%) and the baseline cohort (1.79%). The unadjusted odds ratio (OR) of postoperative pneumonia was 0.90 (95% CI: 0.70, 1.16; p = 0.423) and the OR adjusted for patient characteristics and potential confounders was 0.90 (95% CI: 0.69, 1.19; p = 0.469), comparing the intervention and baseline cohorts. There was no a priori selected subgroup of patients for whom the use of the TaperGuard™ ETT was associated with decreased odds of postoperative pneumonia relative to the standard ETT. Hospital mortality was higher in the intervention cohort (1.5%) compared with the baseline cohort (1.0%; OR 1.46, 95% CI: 1.09, 1.95; p = 0.010).<h4>Conclusions</h4>The broad implementation of the use of the TaperGuard™ ETT for intubation of surgical patients was not associated with a reduction in the risk of postoperative pneumonia. In the setting of a low underlying postoperative pneumonia risk and the use of recommended preventative VAP bundles, further risk reduction may not be achievable by simply modifying the ETT cuff design in unselected or high-risk populations undergoing inpatient surgery.<h4>Trial registration</h4>ClinicalTrials.gov, ID NCT02450929 .
Type
Journal article
Subject
Humans
Postoperative Complications
Risk Factors
Cohort Studies
Equipment Design
Intubation, Intratracheal
Adult
Aged
Middle Aged
Female
Male
Pneumonia, Ventilator-Associated
Interrupted Time Series Analysis
Permalink
https://hdl.handle.net/10161/26497
Published Version (Please cite this version)
10.1186/s12871-020-01117-4
Publication Info
Martini, Ross P; Yanez, N David; Treggiari, Miriam M; Tekkali, Praveen; Soelberg, Cobin; & Aziz, Michael F (2020). Implementation of the TaperGuard™ endotracheal tube in an unselected surgical population to reduce postoperative pneumonia. BMC anesthesiology, 20(1). pp. 211. 10.1186/s12871-020-01117-4. Retrieved from https://hdl.handle.net/10161/26497.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Treggiari

Miriam Treggiari

Instructor Temporary in the Department of Anesthesiology

David Yanez

Professor of Biostatistics & Bioinformatics
Alphabetical list of authors with Scholars@Duke profiles.
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