The Impact of Hospital-Wide Use of a Tapered Cuff Endotracheal Tube on VAP Incidence

Background: Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of VAP. A tapered-cuff endotracheal tube has been demonstrated to reduce aspiration around the cuff.^[1] Whether these properties are efficacious in reducing VAP is not known.

Methods: This two-period investigator-initiated observational study was designed to assess the efficacy of a tapered-cuff endotracheal tube to reduce the rate of VAP. All intubated, mechanically ventilated patients over the age of 18 were included. During the baseline period, a standard barrel cuff ETT (Mallinkrodt^™ Hi-Lo cuff, Covidien LLC, Mansfield, MA) was used. All endotracheal tubes throughout the hospital were then replaced with a tapered cuff ETT (TaperGuard^™ cuff, Covidien LLC, Mansfield, MA). The primary outcome variable was the incidence of VAP per 1,000 ventilator days.

Results: 2,849 patients, encompassing 15,250 ventilator days, were included. The mean monthly VAP rate (mean ± SD) was 3.29 ± 1.79/1000 ventilator days in the Standard Group and 2.77 ± 2.00/1000 ventilator days in the Taper Group (p=0.65). While compliance with the VAP prevention bundle was high throughout the study, bundle compliance was significantly higher during the Standard Group period than in the Taper Group period, 96.5±2.7% and 90.3±3.5% respectively (p=0.01).

Conclusion: In the setting of a rate of VAP very near the average of ICUs in the United States and where there was high compliance with a VAP prevention bundle, the use of a tapered cuff endotracheal tube was not associated with a reduction in the rate of VAP.