Does PEEP reduce the incidence of aspiration around endotracheal tubes?

Despite improved endotracheal tube designs, aspiration remains a cause of pulmonary complications. This in vitro study evaluates the efficacy of positive end-expiratory pressure (PEEP) in reducing the incidence of seepage around endotracheal tubes during mechanical (MV) and spontaneous ventilation (SV). Two transparent plastic "tracheas" with cuffed and uncuffed endotracheal tubes simulated adult and paediatric airways respectively. Ten trials without PEEP and ten with PEEP at each of two different levels were completed for each model using both SV and MV. Simulated SV in both models was associated with seepage nearly 100 per cent of the time, regardless of PEEP level. During MV without PEEP, seepage occurred in 55 per cent of the adult trials and 100 per cent of the paediatric trials. In contrast, MV with 5 cmH2O PEEP produced seepage rates of 15 per cent in the adult model and 0 per cent in the paediatric model. Compared to trials without PEEP, seepage occurred less frequently, was reduced in amount and delayed in onset. MV with PEEP significantly (p less than 0.05) decreased the incidence of seepage around endotracheal tubes.