Squamous Metaplasia of Tracheal Epithelium Associated with High-Volume, Low Pressure Airway Cuffs.

摘要

The tracheas of 12 patients, intubated from 2 hours to 20 days with tracheal airways equipped with high-volume, low-pressure (HVLP) cuffs, were examined at autopsy. The type and severity of iatrogenic damage to the epithelium and submucosa was compared to that seen in a previous study of 54 patients who has been intubated with the older-style low-volume, high-pressure (LVHP) cuffed airways. The tracheal epithelial and submucosal damage due to intubation with the HVLP cuffed airways was considerably less than that with LVHP cuffs. The submucosal glands were often spared, and some of the tracheal epithelium even survived 20 days of exposure to the 'soft cuffs. However, the pseudostratified ciliated epithelium was often replaced by stratified squamous epithelium. If such a zone of nonciliated epithelium remains in the trachea of a long-term survivor, its detrimental effect on the removal of particulate matter from the tracheobronchial tree may have to be considered.