{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:56:40Z","timestamp":1790751400192,"version":"4.1.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T00:00:00Z","timestamp":1555977600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Endotracheal tubes with standard polyvinyl chloride cuffs create folds on inflation into the trachea, which lead to potential leakage of subglottic secretions into the lower airways and cause lung colonization and pneumonia. The use of a double-layer prototype leak-proof cuff has shown effective prevention of the fluid leakage across the cuff. We hypothesized that the use of such a leak-proof cuff could prevent lung bacterial colonization in vivo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>To simulate patients in the ICU, 13 pigs were placed in the semirecumbent position, intubated, and mechanically ventilated for 72 h. Five animals were prospectively intubated with an endotracheal tube with a leak-proof cuff (leak-proof cuff group). Data from 8 animals previously intubated with an endotracheal tube with a standard polyvinyl chloride cuff (standard cuff group) were retrospectively analyzed. Leakage of tracheal secretions across the leak-proof cuff was tested by the macroscopic methylene blue evaluation. Arterial blood gas exchanges and microbiology were tested in all the pigs at necropsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In the standard cuff group, all the pigs showed heavy bacterial colonization of the lungs after 72 h of mechanical ventilation, with an overall proportion of colonized lung lobes of 92% (44\/48 lobes, 8\/8 animals) compared with 27% (8\/30 lobes, 5\/5 animals) in the leak-proof cuff group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). These results were strengthened by the absence of methylene blue in the tracheal secretions below the leak-proof cuff. Furthermore, no hypoxemia was demonstrated in the pigs in the leak-proof cuff group after the 72-h experiment (P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      change from baseline, leak-proof cuff group vs standard cuff group; median difference 332, 95% CI 41\u2013389 mm Hg;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .030).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A new leak-proof cuff for endotracheal intubation prevented macroscopic leakage of subglottic secretions along the airways. This mechanism led to the reduction of lung bacterial colonization, which could contribute to the prevention of hypoxemia in the pigs on mechanical ventilation while in the semirecumbent position.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.06573","type":"journal-article","created":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T17:45:17Z","timestamp":1556041517000},"page":"1031-1041","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevention of Lung Bacterial Colonization With a Leak-Proof Endotracheal Tube Cuff: An Experimental Animal Study"],"prefix":"10.1177","volume":"64","author":[{"given":"Emanuele","family":"Rezoagli","sequence":"first","affiliation":[{"name":"School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy."},{"name":"Regenerative Medicine Institute at C\u00daRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Ireland."},{"name":"Discipline of Anaesthesia, School of Medicine, National University of Ireland, Galway, Ireland."},{"name":"Department of Anesthesia and Intensive Care Medicine, Galway University Hospitals, SAOLTA University Health Group, Galway, Ireland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Cressoni","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Bellani","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy."},{"name":"Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Grasselli","sequence":"additional","affiliation":[{"name":"Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universit\u00e0 degli Studi di Milano, Milan, Italy."},{"name":"Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio M","family":"Pesenti","sequence":"additional","affiliation":[{"name":"Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universit\u00e0 degli Studi di Milano, Milan, Italy."},{"name":"Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodor","family":"Kolobow","sequence":"additional","affiliation":[{"name":"National Institutes of Health, Bethesda, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Zanella","sequence":"additional","affiliation":[{"name":"Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universit\u00e0 degli Studi di Milano, Milan, Italy."},{"name":"Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,4,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3325"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70081-1"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328014daac"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000049943.01252.E5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000299741.32078.E9"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10550294"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-012-2495-2"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001899"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1016-9"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-010-2106-z"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01099"},{"key":"e_1_3_3_13_2","volume-title":"NIH Publication No. 86-23","author":"National Institutes of Health: Guide for the Care and Use of Laboratory Animals","year":"1985","unstructured":"National Institutes of Health: Guide for the Care and Use of Laboratory Animals. 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