Implementation of the TaperGuard™ endotracheal tube in an unselected surgical population to reduce postoperative pneumonia.
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 articleSubject
HumansPostoperative Complications
Risk Factors
Cohort Studies
Equipment Design
Intubation, Intratracheal
Adult
Aged
Middle Aged
Female
Male
Pneumonia, Ventilator-Associated
Interrupted Time Series Analysis
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https://hdl.handle.net/10161/26497Published Version (Please cite this version)
10.1186/s12871-020-01117-4Publication 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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Show full item recordScholars@Duke
Miriam Treggiari
Paul G. Barash Distinguished Professor of Anesthesiology
David Yanez
Professor of Biostatistics & Bioinformatics
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