HELPING REDUCE THE TRACHEAL IMPACT OF INTUBATION1. Endotracheal tubes with TaperGuard cuff technology in the operating room

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1 HELPING REDUCE THE TRACHEAL IMPACT OF INTUBATION1 Endotracheal tubes with TaperGuard cuff technology in the operating room

SECURING AIRWAYS WITH A GENTLE TOUCH You aim to keep patients safe and comfortable so they have their best chance at a positive postsurgical outcome.

1-7 WHY YOUR TOOLS MATTER Friction or pressure between the tracheal cuff and the trachea s sensitive mucosa can lead to irritation, ischemia and tracheal trauma.

2 SECURING AIRWAYS WITH A GENTLE TOUCH You aim to keep patients safe and comfortable so they have their best chance at a positive postsurgical outcome. The equipment you choose for intubation in the OR can help make a difference. 1-7 WHY YOUR TOOLS MATTER Friction or pressure between the tracheal cuff and the trachea s sensitive mucosa can lead to irritation, ischemia and tracheal trauma. 6,12 It doesn t take long for excess pressure to cause damage. Poorly controlled cuff pressures have been associated with postsurgical sore throat, 6,7 cough, hoarseness and blood-streaked expectoration, even after procedures of only one to three hours. 6

GETTING PRESSURE RIGHT Many factors play into cuff pressures, from the cuff volume and material to the tracheal diameter, 1,5 which varies with each patient s size and age.

3 GETTING PRESSURE RIGHT Many factors play into cuff pressures, from the cuff volume and material to the tracheal diameter, 1,5 which varies with each patient s size and age. 13 High-volume, low-pressure (HVLP) cuffs were introduced to help avoid tracheal damage. 12,14 However, the surface of an HVLP often folds to fit within the trachea and has demonstrated a less uniform pressure exertion against the tracheal wall. 5 Newer, taper-shaped cuffs can both enhance fit * across patients and reduce pressure impact on the trachea. 3,5,15,16 Lateral wall pressure generated by the endotracheal cuff is thought to be the most important factor in tracheal morbidity due to intubation with cuffed endotracheal tubes. Seegobin and van Hasselt, * Compared with traditional HVLP cuffs.

TAPERGUARD CUFF TECHNOLOGY: THE LOW-IMPACT, LOW-PRESSURE ENDOTRACHEAL TUBE Endotracheal tubes with TaperGuard cuff technology have features that may help reduce the tracheal impact of intubation with

16 TAPERED-CUFF ADVANTAGES Unique TaperGuard cuff design: Reduces the area of tracheal impact by 50% or more versus cylindrical PVC cuffs 3,5,15 Reduces intracuff pressure required to obtain an

4 TAPERGUARD CUFF TECHNOLOGY: THE LOW-IMPACT, LOW-PRESSURE ENDOTRACHEAL TUBE Endotracheal tubes with TaperGuard cuff technology have features that may help reduce the tracheal impact of intubation with a unique, taper-shaped cuff design that provides a smaller area of contact with the patient s airway than traditional barrel-shaped cuffs. 16 TAPERED-CUFF ADVANTAGES Unique TaperGuard cuff design: Reduces the area of tracheal impact by 50% or more versus cylindrical PVC cuffs 3,5,15 Reduces intracuff pressure required to obtain an adequate seal compared to Mallinckrodt Hi-Lo cuffs 17 Provides more uniform pressure distribution than Mallinckrodt Hi-Lo cuffs at equivalent intracuff pressures 5 Reduces microaspiration by as much as 90% compared to Mallinckrodt Hi-Lo cuffs 18 Proper control of [cuff] pressure helped reduce postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours). Liu et al.,

5 IMPROVED DESIGN TO HELP REDUCE THE IMPACT OF INTUBATION Cuff design can influence the tracheal impact of intubation.5,16 The unique shape of the TaperGuard cuff may help you avoid mucosal ischemia and reduce the incidence of tracheal injury,3 for less risk of postoperative irritation4 compared to standard PVC cuffs.

6 SPECIFICATIONS DESCRIPTION I.D. O.D. CATALOG NUMBER 5.0 mm 6.9 mm mm 7.5 mm mm 8.2 mm Mallinckrodt TaperGuard Oral/Nasal Endotracheal Tube, Murphy Eye Learn more The Mallinckrodt TaperGuard oral endotracheal tube Photo credit: Thinkstock 6.5 mm 8.9 mm mm 9.5 mm mm 10.2 mm mm 10.8 mm mm 11.4 mm mm 12.1 mm mm 13.5 mm Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 02/ AW-0017 [REF#611590] References 1. Lichtenthal PR, Borg UB. Endotracheal cuff pressure: role of tracheal size and cuff volume. Crit Care. 2011;15: Smetana GW, Lawrence VA, Cornell JE, American College of P. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144: Li Bassi G, Ranzani OT, Marti JD, et al. An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures. Crit Care Med. 2013;41: McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999;54: Lichtenthal PR, Wood L, Wong A, Borg U. Pressure applied to tracheal wall by barrel and taper shaped cuffs. Paper presented at: Anesthesiology 2011 American Society of Anesthesiologists Annual Meeting; October 15-19, 2011; Chicago, IL. htm;jsessionid=53eabf8a93f80bafcb5d4879af65c145?year=2011&index=8&absnum= Liu J, Zhang X, Gong W. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010;111(5): Calder A, Hegarty M, Erb TO, von Ungern-Sternberg BS. Predictors of postoperative sore throat in intubated children. Paediatr Anaesth. 2012;22(3): Arozullah AM, Khuri SF, Henderson WG, Daley J, Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med. 2001;135: Khan NA, Quan H, Bugar JM, et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21: Hemmila MR, Jakubus JL, Maggio PM, et al. Real money: complications and hospital costs in trauma patients. Surgery. 2008;144: Linde-Zwirble WL, Bloom JD, Mecca RS, Hansell DM. Postoperative pulmonary complications in adult elective surgery patients in the US: severity, outcomes and resources use. Crit Care. 2010; 14(Suppl 1):P Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288(6422): Sakuraba S, Serita R, Kuribayashi J, et al. Comparison of tracheal diameter measured by chest x-ray and by computed tomography. Anesthesiol Res Pract. 2010;Epub Seegobin RD, van Hasselt GL. Aspiration beyond endotracheal cuffs. Can Anaesth Soc J. 1986;33(3 Pt 1): Shiotsuka J, Lefor AT, Sanui M, Nagata O, Horiguchi A, Sasabuchi Y. A quantitative evaluation of fluid leakage around a polyvinyl chloride tapered endotracheal tube cuff using an in-vitro model. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(3): Kelley S, Chien HL, Erslon M, Weinmann M. Impact of cuff shape on outcomes of patients intubated with endotracheal tubes with subglottic secretion drainage. Am J Resp Crit Care Med. 2013;A Tsuboi S, Miyashita T, Yamaguchi Y, et al. The TaperGuardTM endotracheal tube intracuff pressure increase is less than that of the Hi-LoTM tube during nitrous oxide exposure: a model trachea study. Anesth Analg. 2013;116: Lichtenthal PR, Maul D, Borg U. Do tracheal tubes prevent microaspiration? Br J Anaesth. 2011;107(5): Gunbarrel Avenue Boulder, CO medtronic.com/covidien

HELP PROTECT YOUR PATIENTS AND PREVENT COMPLICATIONS.

HELP PROTECT YOUR PATIENTS AND PREVENT COMPLICATIONS. Clinician-inspired tools for the operating room McGRATH MAC video laryngoscope and Shiley airway management products AIRWAY MANAGEMENT TOOLS INSPIRED