HELPING REDUCE THE TRACHEAL IMPACT OF INTUBATION1

Endotracheal tubes with TaperGuard™ cuff technology in the operating room

SECURING AIRWAYS WITH A GENTLE TOUCHYou aim to keep patients safe and comfortable so they have their best chance at a positive postsurgical outcome. The equipment you choose for intubation in the OR can help make adifference.1-7

WHY YOUR TOOLS MATTER

Friction or pressure between the tracheal cuff and the trachea’s sensitive mucosa can lead to irritation, ischemia and tracheal trauma.6,12

It doesn’t take long for excess pressure to cause damage. Poorly controlled cuff pressures have been associated with postsurgical sore throat,6,7 cough, hoarseness and blood-streakedexpectoration, even after procedures of only one to three hours.6

Many factors play into cuff pressures, from the cuff volume and material to the tracheal diameter,1,5 which varies with each patient’s size and age.13

High-volume, low-pressure (HVLP) cuffs were introduced to help avoid tracheal damage.12,14 However, the surface of an HVLP often folds to fit within the trachea and has demonstrated a less uniform pressure exertion against the tracheal wall.5

Newer, taper-shaped cuffs can both enhance fit* across patients and reduce pressure impact on the trachea.3,5,15,16

GETTING PRESSURE RIGHT

“Lateral wall pressure generated by the endotracheal cuff is thought to be the most important factor in tracheal morbidity due to intubation with cuffed endotracheal tubes.”Seegobin and van Hasselt, 198614

*Compared with traditional HVLP cuffs.

Endotracheal tubes with TaperGuard™ cuff technology have features that may help reduce the tracheal impact ofintubation with a unique, taper-shaped cuff design that provides a smaller area of contact with the patient’s airway than traditional barrel-shaped cuffs.16

TAPERGUARD™ CUFF TECHNOLOGY:THE LOW-IMPACT, LOW-PRESSURE ENDOTRACHEAL TUBE

TAPERED-CUFF ADVANTAGES Unique TaperGuard™ cuff design:

∙ Reduces the area of tracheal impact by 50% or more versus cylindrical PVC cuffs3,5,15

∙ Reduces intracuff pressure required to obtain an adequate seal compared to Mallinckrodt™ Hi-Lo cuffs17

∙ Provides more uniform pressure distribution than Mallinckrodt™ Hi-Lo cuffs at equivalent intracuff pressures5

∙ Reduces microaspiration by as much as 90% compared to Mallinckrodt™ Hi-Lo cuffs18

“Proper control of [cuff] pressure…helped reduce…postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours).”

Liu et al., 20106

Cuff design can influence the tracheal impact of intubation.5,16

The unique shape of the TaperGuard™ cuff may help you avoid mucosal ischemia and reduce the incidence of tracheal injury,3 for less risk of postoperative irritation4 compared to standard PVC cuffs.

IMPROVED DESIGN TO HELP REDUCE THE IMPACT OF INTUBATION

Learn moreThe Mallinckrodt™ TaperGuard™ oral endotracheal tube

SPECIFICATIONS References1. Lichtenthal PR, Borg UB. Endotracheal cuff pressure: role of tracheal size and cuff volume. Crit Care. 2011;15:147.2. Smetana GW, Lawrence VA, Cornell JE, American College of P. Preoperative pulmonary risk stratification for

noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144: 581–595.

3. Li Bassi G, Ranzani OT, Marti JD, et al. An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures. Crit Care Med. 2013;41:518–526.

4. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999;54:444–453.5. Lichtenthal PR, Wood L, Wong A, Borg U. Pressure applied to tracheal wall by barrel and taper shaped

cuffs. Paper presented at: Anesthesiology 2011 American Society of Anesthesiologists Annual Meeting; October 15-19, 2011; Chicago, IL. http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=53EABF8A93F80BAFCB5D4879AF65C145?year=2011&index=8&absnum=5240

6. Liu J, Zhang X, Gong W. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010;111(5):1133–1137.

7. Calder A, Hegarty M, Erb TO, von Ungern-Sternberg BS. Predictors of postoperative sore throat in intubated children. Paediatr Anaesth. 2012;22(3):239-243.

8. Arozullah AM, Khuri SF, Henderson WG, Daley J, Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med. 2001;135:847–857.

9. Khan NA, Quan H, Bugar JM, et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21:177–180.

10. Hemmila MR, Jakubus JL, Maggio PM, et al. Real money: complications and hospital costs in trauma patients. Surgery. 2008;144:307–316.

11. Linde-Zwirble WL, Bloom JD, Mecca RS, Hansell DM. Postoperative pulmonary complications in adult elective surgery patients in the US: severity, outcomes and resources use. Crit Care. 2010; 14(Suppl 1):P210.

12. Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288(6422):965–968.

13. Sakuraba S, Serita R, Kuribayashi J, et al. Comparison of tracheal diameter measured by chest x-ray and by computed tomography. Anesthesiol Res Pract. 2010;Epub 2010.

14. Seegobin RD, van Hasselt GL. Aspiration beyond endotracheal cuffs. Can Anaesth Soc J. 1986;33(3 Pt 1):273–279.15. Shiotsuka J, Lefor AT, Sanui M, Nagata O, Horiguchi A, Sasabuchi Y. A quantitative evaluation of fluid leakage around a

polyvinyl chloride tapered endotracheal tube cuff using an in-vitro model. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(3):169–175.

16. Kelley S, Chien HL, Erslon M, Weinmann M. Impact of cuff shape on outcomes of patients intubated with endotracheal tubes with subglottic secretion drainage. Am J Resp Crit Care Med. 2013;A2807.

17. Tsuboi S, Miyashita T, Yamaguchi Y, et al. The TaperGuardTM endotracheal tube intracuff pressure increase is less than that of the Hi-LoTM tube during nitrous oxide exposure: a model trachea study. Anesth Analg. 2013;116:609–612.

18. Lichtenthal PR, Maul D, Borg U. Do tracheal tubes prevent microaspiration? Br J Anaesth. 2011;107(5):821-822.

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DESCRIPTION I.D. O.D.CATALOG NUMBER

Mallinckrodt™ TaperGuard™ Oral/Nasal Endotracheal Tube, Murphy Eye

5.0 mm 6.9 mm 18750

5.5 mm 7.5 mm 18755

6.0 mm 8.2 mm 18760

6.5 mm 8.9 mm 18765

7.0 mm 9.5 mm 18770

7.5 mm 10.2 mm 18775

8.0 mm 10.8 mm 18780

8.5 mm 11.4 mm 18785

9.0 mm 12.1 mm 18790

10.0 mm 13.5 mm 18710