• Jan Poelaert, Patrick Haentjens, and Stijn Blot.
• Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine and Pharmacology, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: Jan.poelaert@uzbrussel.be.
• J. Thorac. Cardiovasc. Surg.. 2014 Oct 1;148(4):1622-7.

ObjectivesPostoperative pulmonary complications are a burden for high-risk surgical patients with a risk of aspiration of subglottic secretions along the polyvinyl chloride cuff. The introduction of a polyurethane cuff diminishes secretion leakage with a decreased rate of pneumonia. The aim of the current analysis was to determine the time at which a polyurethane cuffed endotracheal tube might be advantageous to prevent aspiration in a setting of high-risk surgical patients.MethodsThe present investigation is based on published data obtained in postoperative cardiac surgical patients undergoing operation from 2006 to 2007. Cuff pressure was kept between 20 and 26 cmH2O intraoperatively and in the intensive care unit. The current post hoc analysis determines (1) the discriminatory cutoff value of intubation duration for predicting postoperative pneumonia and (2) the potential factors associated with prolonged intubation.ResultsForty-three patients (32%) were diagnosed with early postoperative pneumonia. Receiver operating characteristics analysis revealed a cutoff value of 16.6 hours for the duration of mechanical ventilation to discriminate patients with postoperative pneumonia. A stepwise binary logistic regression analysis revealed that a polyvinyl chloride cuff was associated with a 10-fold increased risk for prolonged intubation.ConclusionsThe current analyses provide evidence that among cardiac surgical patients, mechanical ventilation more than 16.6 hours is associated with an increased likelihood of postoperative pneumonia.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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