Effect of a novel anatomically shaped endotracheal tube on intubation-related injury

To develop an anatomically shaped endotracheal tube (ETT) and to compare the degree of induced laryngeal injury of this ETT with that of a standard ETT using an animal model.

Randomized controlled animal study.

Eight Sus scrofa piglets (15-20 kg) randomly intubated with either a standard or a modified uncuffed ETT.

The modified ETT was handcrafted by gluing and then trimming dry polyvinyl acetate foam circumferentially to the distal end of a standard uncuffed ETT. After intubation, the foam quickly self-expanded as it absorbed the secretions of the laryngopharynx and adopted the shape of the intraluminal airway. This conforming shape also sealed the larynx to allow for positive pressure ventilation. Both groups were intubated for 4 hours under constant hypoxic conditions (mean oxygen saturation <70%) to enhance and accelerate intubation damage. They were then humanely killed, and the larynx and trachea were harvested for histologic examination.

The severity of laryngeal injury graded on a scale from 0 to 4 (0 indicates normal; 1, epithelial compression; 2, epithelial loss; 3, subepithelial and glandular necrosis; and 4, perichondrium involvement).

All of the specimens histologically demonstrated areas of inflammation and epithelial loss. The standard ETT caused substantial deep damage, with a mean (SD) severity score of 2.79 (0.74). The modified ETT caused mainly superficial damage, with a mean (SD) severity score of 1.65 (0.56) (P < .001).

The modified ETT objectively caused less laryngotracheal damage compared with the standard ETT and may be of potential clinical benefit.