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Covidien's taper-shaped cuff improves intubation safety.

In the 1970s, Covidien introduced the Hi-Lo endotracheal tube. Now the standard of care for intubating patients has leaped forward again, thanks to its next-generation, innovative taper-shaped cuff, the TaperGuard endotracheal tube.

The unique design has shown it can improve patient safety by reducing microaspiration, which is associated with a variety of pulmonary complications, including pneumonia.


"Research has shown that the new tapered design significantly reduces the leakage past the endotracheal tube cuff, limiting passage of foreign material into the airways and lungs," said Jonathan Bloom, MD, associate direcsor of Medical Affairs at Covidien, the leading provider and innovator of healthcare products.

The TaperGuard Evac endotracheal tube combines the TaperGuard cuff with Mallinckrodt Evac technology, offering secretion management capabilities by enabling continuous or intermittent drainage of secretions that collect above the cuff.

Its innovative taper-shaped cuff design substantially reduces microaspiration by an average of 90 percent compared with the conventional barrel-shaped PVC cuff found on the Mallinckrodt Hi-Lo endotracheal tube, the industry's most widely-used endotracheal tube.

"Some of the greatest innovations are fairly simple," Bloom explained. "I am struck by the elegance of this design."

Reducing Microaspiration

Medical literature over the past four decades suggests that post-intubation pulmonary complications are costly and associated with increased morbidity and mortality. The four most commonly cited pulmonary complications after surgery include: pneumonia, respiratory failure, atelectasis and acute exacerbation of chronic lung disease.

The TaperGuard launched last fall, debuting at the American Society of Anesthesiology in New Orleans and the European Society of Intensive Care Medicine in Vienna. And John Burns, Covidien's global product manager for Airway Management, said that hospitals have been quickly adding the device to their departments.


"This cuff is resonating with customers. We're seeing significant adoption as it quickly replaces older technologies," he told FOCUS. This product line illustrates Covidien's commitment to developing innovative, proven solutions for commonly occurring healthcare complications like these, with the goal of decreasing patient mortality, as well as healthcare costs.

Proven Solution

Emerging clinical studies are beginning to demonstrate the design's simplicity is effective as well. New research by P.B. Batchelder of Clinimark Labs in Golden, Colo., concluded that the Mallinckrodt TaperGuard endotracheal tube provided a more effective seal against fluid leakage, when compared with six other tubes.

"Over the past few years, numerous cuffs and endotracheal tubes have been developed and introduced by industry. The large number of available products have prompted multiple investigators to test their performance side-by-side," Bloom said.

The largest of these studies, performed by Bachelder, et al., investigated how well various cuff designs prevented leakage past the tube cuff. Ten tubes of each design were tested five times, for a total of 50 trials per cuff.

Results indicated considerable differences in sealing ability. The TaperGuard cuff came in first overall. It provided superior performance, with an average leak rate of just 0.59 grams of water over a five-minute period. Other cuff designs didn't function as well, indicating leak rates that ranged from 11.19 to 59.18 grams of water in five minutes.

By providing a more effective tracheal seal, the TaperGuard tube reduces the risk of microaspiration among intubated patients. Data suggests that, with conventional endotracheal tubes, microaspiration can occur at any time from intubation to extubation. Reducing risks of aspiration of fluid, secretions and other materials that have leaked past the endotracheal tube cuff and into the lungs can reduce the incidence of ventilator-associated pneumonia (VAP), the most common hospital-acquired infection and the leading cause of morbidity and mortality in the intensive care unit.

"With this new cuff you may reduce microaspiration, helping to fight VAP in probably the biggest way it is occurring," Bloom said. Consider a 2009 study published in the New England Journal of Medicine reported more than 22 percent of Medicare readmissions are surgical patients and the pneumonia as the second most common reason for rehospilalization. In fact, these unplanned rehospitalizations account of $17.4 billion in healthcare costs.

"The ability of the TaperGuard tube to reduce microaspiration means better patient outcomes as well as substantial cost-savings for healthcare facilities," said Douglas Hansell, MD, MPH, chief medical officer and vice president of Respiratory and Monitoring Solutions at Covidien.

For more information TaperGuard endotracheal tube and Covidien's other medical products, visit

Shawn Proctor is a freelance medical writer in Philadelphia.
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Author:Proctor, Shawn
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Date:Jul 1, 2010
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