Advanced cuff pressure control ventilation (ACPCV); a bench study of a new concept of mechanical ventilation

The concept of advanced cuff pressure control ventilation (ACPCV) is that the endotracheal tube (ETT) cuff volume could be controlled and allowed to exhale the gas through the vocal cords. The potential advantages of ACPCV are reduction of dead space, reduction of expiratory airway resistance, and preservation of vocal cord function. We developed the ACPCV system and investigated its performance in bench studies. The ETT cuff volume was regulated via four steps, depending on airway pressure and tracheal pressure. Two ventilatory settings were examined under several rates of spontaneous breathing efforts. Imposed expiratory resistance (R), imposed expiratory work of breathing (WOB), and auto-PEEP of ACPCV were compared with continuous mandatory ventilation (CMV). R of ACPCV (2.6 ± 0.5 cm H₂O/l/s) was significantly lower than that of CMV (11.6 ± 1.6 cm H₂O/l/s) (p < 0.001). Expiratory WOB of ACPCV (0.25 ± 0.02 J/l) was significantly lower than that of CMV (0.54 ± 0.10 J/l) (p < 0.001). Auto-PEEP of ACPCV (-0.6 ± 0.2 cm H₂O) was significantly lower than that of CMV (1.1 ± 0.7 cm H₂O) (p < 0.001). ACPCV can significantly reduce R and expiratory WOB by controlling the ETT cuff volume in synchronisation with mechanical ventilation.