{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:19:27Z","timestamp":1788365967855,"version":"build-2803163510"},"reference-count":8,"publisher":"Mattioli1885","issue":"Vol. 21 (2026)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:p>Background: Inadequate endotracheal tube (ETT) cuff sealing permits microaspiration of subglottic secretions, driving ventilator-associated pneumonia and perioperative respiratory complications. Standard cylindrical and tapered cuffs remain susceptible to microchannel formation and leakage. This pilot study evaluated a novel ETT with a 90-mm self-expanding viscoelastic cuff (V-Cuff\u00ae) operating at ambient pressure compared to standard and specialty ETTs in vitro. Methods: Five ETTs of each type\u2014standard cylindrical (Ruschelit\u00ae), specialty tapered (Shiley Evac\/TaperGuard\u00ae), and V-Cuff\u00ae\u2014were tested at 37\u00b0C in a 3D-printed tracheal model with 5 cmH\u2082O positive end-expiratory pressure (PEEP). Evaluations included upper and lower pressure threshold assessments (UPTA and LPTA) and simulated swallowing (80 mmHg, 2s) and coughing (125 mmHg, 3s). Continuous and categorical outcomes were analyzed using Mann-Whitney U and Fisher's Exact tests, respectively. Results: Under 5 cmH\u2082O PEEP, the standard ETT leaked immediately at 0 mmHg on UPTA. Both specialty and V-Cuff\u00ae ETTs tolerated supracuff pressures &gt;90 mmHg on UPTA (p&lt;0.001 vs. standard). On LPTA, air leak occurred at a mean of 5 \u00b1 0.71 mmHg (standard) and 12 \u00b1 1.22 mmHg (specialty), whereas the V-Cuff\u00ae showed no leakage at pressures &gt;90 mmHg (p=0.008 vs. standard and specialty). During simulated swallowing and coughing, all standard and specialty ETTs leaked (5\/5), while the V-Cuff\u00ae maintained complete seal integrity without leakage (0\/5; p=0.008). Conclusions: In this pilot in vitro study, the V-Cuff\u00ae ETT demonstrated superior airway sealing under all static and dynamic conditions compared to standard and tapered-cuff ETTs. These preliminary findings suggest the improved seal may reduce tracheal soiling, though prospective clinical validation is required to confirm reductions in aspiration-related complications.<\/jats:p>","DOI":"10.5826\/mrm.2026.1094","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:40:56Z","timestamp":1788363656000},"page":"1094","source":"Crossref","is-referenced-by-count":0,"title":["Pilot study comparing the quality of airway seal in an endotracheal tube with a viscoelastic cuff compared to standard endotracheal tubes"],"prefix":"10.5826","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8022-1947","authenticated-orcid":false,"given":"Pedro Alejandro","family":"Bravo Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Universidad de la Laguna, Tenerife, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8397-2363","authenticated-orcid":false,"given":"Daniel A","family":"Cuevas Nieves","sequence":"additional","affiliation":[{"name":"Hospital Nuestra Se\u00f1ora Se\u00f1ora de la Candelaria. Santa Cruz de Tenerife, Canary Islands Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6785-9774","authenticated-orcid":false,"given":"Nieves","family":"Leon-Gomez","sequence":"additional","affiliation":[{"name":"Hospital Nuestra Se\u00f1ora Se\u00f1ora de la Candelaria. Santa Cruz de Tenerife, Canary Islands Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1177-1551","authenticated-orcid":false,"given":"Juan Jose","family":"Artazkoz del Toro","sequence":"additional","affiliation":[{"name":"Hospital Nuestra Se\u00f1ora Se\u00f1ora de la Candelaria. Santa Cruz de Tenerife, Canary Islands Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7909-2282","authenticated-orcid":false,"given":"Ricardo","family":"Martinez-Ruiz","sequence":"additional","affiliation":[{"name":"Rooney Heart Institute, Naples Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27750","reference":[{"key":"10.5826\/mrm.2026.1094_ref1","doi-asserted-by":"crossref","unstructured":"1. Michikoshi J, Yamamoto M, Takagi K, Kudo T, Tange Y, Tomo T. Evaluating the sealing capacities of different endotracheal tube cuff designs. Respir Care 2025;70:962-7.","DOI":"10.1089\/respcare.12465"},{"key":"10.5826\/mrm.2026.1094_ref2","doi-asserted-by":"crossref","unstructured":"2. Bravo PL, Gonzalez Sammarco F, Cueva Nieves DA, Lorente L, Delgado J, Martinez-Ruiz R. Innovative endotracheal tube design reduces laryngeal injury with an excellent airway seal and minimal cuff pressures. Anesth Analg 2025;140:983-5.","DOI":"10.1213\/ANE.0000000000007260"},{"key":"10.5826\/mrm.2026.1094_ref3","doi-asserted-by":"crossref","unstructured":"3. Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med 2003;29:1849-53.","DOI":"10.1007\/s00134-003-1933-6"},{"key":"10.5826\/mrm.2026.1094_ref4","doi-asserted-by":"crossref","unstructured":"4. Zanella A, Scaravilli V, Isgr\u00f2 S, Milan M, Cressoni M, Patroniti N, et al. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med 2011;37:343-7.","DOI":"10.1007\/s00134-010-2106-z"},{"key":"10.5826\/mrm.2026.1094_ref5","doi-asserted-by":"crossref","unstructured":"5. Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M. Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth 2010;105:538-43.","DOI":"10.1093\/bja\/aeq202"},{"key":"10.5826\/mrm.2026.1094_ref6","doi-asserted-by":"crossref","unstructured":"6. Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, Durocher A, et al. Continuous control of tracheal cuff pressure and microaspiration of gastric contents in critically ill patients. Am J Respir Crit Care Med 2011;184:1041-7.","DOI":"10.1164\/rccm.201104-0630OC"},{"key":"10.5826\/mrm.2026.1094_ref7","doi-asserted-by":"crossref","unstructured":"7. Rello J, So\u00f1ora R, Jubert P, Artigas A, Rue M, Valles J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med 1996;154:111-5.","DOI":"10.1164\/ajrccm.154.1.8680665"},{"key":"10.5826\/mrm.2026.1094_ref8","doi-asserted-by":"crossref","unstructured":"8. Mariyaselvam MZ, Marsh L, Wise MP, Williams DW. An in vitro microbiological study comparing eight endotracheal tubes and their ability to prevent microaspiration. Intensive Care Med Exp 2015;3(Suppl 1):A382.","DOI":"10.1186\/2197-425X-3-S1-A382"}],"container-title":["Multidisciplinary Respiratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/mrmjournal.org\/index.php\/mrm\/article\/download\/1094\/1605","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/mrmjournal.org\/index.php\/mrm\/article\/download\/1094\/1605","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:40:57Z","timestamp":1788363657000},"score":1,"resource":{"primary":{"URL":"https:\/\/mrmjournal.org\/index.php\/mrm\/article\/view\/1094"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":8,"journal-issue":{"issue":"Vol. 21 (2026)"},"URL":"https:\/\/doi.org\/10.5826\/mrm.2026.1094","relation":{"has-manifestation":[{"id-type":"other","id":"1-44-1094-g1605","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-44","asserted-by":"subject"}]},"ISSN":["2049-6958","1828-695X"],"issn-type":[{"value":"2049-6958","type":"electronic"},{"value":"1828-695X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}