Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes
4 affiliations
- 1Servicio Vasco de Salud – Osakidetza. Universidad de la Laguna, Tenerife, Spain
- 2Departamento de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
- 3Speech and Language Therapist (SLT) Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain
- 4Cardiovascular Intensive Care Unit, Rooney Heart Institute, Naples Community Hospital, Naples, Florida, USA
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.
Methods: 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.
Results: 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).
Conclusions: 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.
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BibTeX
@article{fernandez2026pilot,
title = {{Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes}},
author = {Pedro Alejandro Bravo Fernández and Daniel A. Cueva Nieves and Nieves Leon-Gomez and Juan José Artazkoz del Toro and Ricardo Martinez-Ruiz},
journal = {Multidisciplinary Respiratory Medicine},
year = {2026},
month = sep,
doi = {10.5826/mrm.2026.1094},
url = {https://doi.org/10.5826/mrm.2026.1094},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes
AU - Pedro Alejandro Bravo Fernández
AU - Daniel A. Cueva Nieves
AU - Nieves Leon-Gomez
AU - Juan José Artazkoz del Toro
AU - Ricardo Martinez-Ruiz
PY - 2026
DA - 2026/09/02
JO - Multidisciplinary Respiratory Medicine
DO - 10.5826/mrm.2026.1094
UR - https://doi.org/10.5826/mrm.2026.1094
AB - 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. Methods: 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. Results: 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). Conclusions: 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.
SN - 1828-695X
SN - 2049-6958
ER -