{
  "abstract": "Background: Inadequate endotracheal tube (ETT) cuff sealing permits microaspiration of subglottic secretions, a primary driver of ventilator-associated pneumonia (VAP) and perioperative respiratory complications. Both standard cylindrical and specialty tapered cuffs are susceptible to microchannel formation, allowing leakage even at recommended inflation pressures. This pilot study evaluated a novel ETT with a 90-mm self-expanding viscoelastic cuff (V-Cuff®) operating at ambient pressure and compared its sealing performance to standard and specialty ETTs under controlled in vitro conditions.\n\nMethods: Five ETTs of each type – standard cylindrical cuff (Ruschelit®, Teleflex Medical), specialty tapered cuff (Shiley Evac/TaperGuard®, Medtronic), and V-Cuff® (Medis Medical LTD) – were tested in a temperature-controlled (37°C) airway workstation using a 3D-printed tracheal model with 5 cmH2O positive end-expiratory pressure (PEEP) applied uniformly to the lower segment in all tests. Tests included upper and lower pressure threshold assessments (UPTA and LPTA, respectively), and simulations of swallowing (80 mmHg, 2 seconds) and coughing (125 mmHg, 3 seconds). Statistical analysis used the Mann-Whitney U test for continuous outcomes and Fisher’s Exact Test for categorical outcomes.\n\nResults: Under uniform 5 cmH2O PEEP conditions, the standard ETT demonstrated immediate leakage at 0 mmHg on UPTA; the specialty ETT achieved a seal under PEEP, tolerating supracuff pressures exceeding 90 mmHg. The V-Cuff® maintained complete seal integrity from 0 mmHg onwards under all UPTA conditions. Both the specialty ETT and V-Cuff® tolerated supracuff pressures exceeding 90 mmHg on UPTA (p<0.001 vs. standard; Fisher’s Exact Test, exact p<0.001). On LPTA, air leak occurred at a mean of 5 ± 0.71 mmHg (standard) and 12 ± 1.22 mmHg (specialty); the V-Cuff® showed no leakage at pressures exceeding 90 mmHg (Mann-Whitney U, p=0.008 vs. standard; p=0.008 vs. specialty). All standard and specialty ETTs leaked during simulated swallowing and coughing (5/5); the V-Cuff® demonstrated no leakage under either condition (0/5; Fisher’s Exact Test, exact p=0.008).\n\nConclusions: In this exploratory pilot in vitro study, the V-Cuff® ETT demonstrated superior airway sealing under all static and dynamic conditions compared to standard and tapered-cuff ETTs, with no leakage events across any test. These preliminary findings suggest that the improved seal may reduce tracheal soiling and airway contamination; whether this translates to a reduction in aspiration-related pulmonary complications requires prospective clinical validation.",
  "abstract_shown": true,
  "affiliations": [
    "Servicio Vasco de Salud – Osakidetza. Universidad de la Laguna, Tenerife, Spain",
    "Departamento de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain",
    "Speech and Language Therapist (SLT) Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain",
    "Cardiovascular Intensive Care Unit, Rooney Heart Institute, Naples Community Hospital, Naples, Florida, USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Pedro Alejandro Bravo Fernández"
    },
    {
      "affs": [
        1
      ],
      "name": "Daniel A. Cueva Nieves"
    },
    {
      "affs": [
        2
      ],
      "name": "Nieves Leon-Gomez"
    },
    {
      "affs": [
        1
      ],
      "name": "Juan José Artazkoz del Toro"
    },
    {
      "affs": [
        3
      ],
      "name": "Ricardo Martinez-Ruiz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dqjs3aw3twh1c.bib",
  "cited_by": 0,
  "doi": "10.5826/mrm.2026.1094",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13722448/",
  "id": "dqjs3aw3twh1c",
  "issns": [
    "1828-695X",
    "2049-6958"
  ],
  "landing_url": "https://doi.org/10.5826/mrm.2026.1094",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Short Report"
    ],
    [
      "openalex",
      "2703|Airway Management and Intubation Techniques"
    ]
  ],
  "openalex": "W7206177647",
  "pdf_url": "https://mrmjournal.org/index.php/mrm/article/download/1094/1605",
  "pmcid": "PMC13722448",
  "pmid": "42684803",
  "published": "2026-09-02",
  "publisher": "Mattioli 1885",
  "ris": "https://research.draconitic.com/paper/dqjs3aw3twh1c.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T12:22:57Z",
      "native_id": "PMC13722448",
      "source": "pmc",
      "url": "https://doi.org/10.5826/mrm.2026.1094"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2703|Airway Management and Intubation Techniques",
      "subfield": "surgery"
    }
  ],
  "title": "Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes",
  "title_text": "Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:22:57Z",
  "url": "https://research.draconitic.com/paper/dqjs3aw3twh1c",
  "venue": "Multidisciplinary Respiratory Medicine",
  "versions": []
}