Covidien公司宣佈Mallinckrodt™ TaperGuard™ 氣管內管在全球上市

一種預防插管病人發生aspiration pneumonia的新型氣管內管(10/19/2009)獲得FDA的核准，可以在市場發售。根據公司內部的資料，比傳統的high volume low pressure cuff Endotracheal tube 減少81%的滲漏量。

TaperGuard氣管內管配置了一種由聚氯乙烯 (PVC) 製成的獨有錐形套囊，旨在顯著減少咽喉部的微吸入。另一個產品，TaperGuard Evac氣管內管則額外提供了一根一體化的抽吸管，以引流分泌物。TaperGuard Evac氣管內管可由此減少呼吸器相關性肺炎 (VAP). 這個設計是擷取Continuous Aspiration of Subglottic Secretions 的觀念與臨床實驗結果



Influence of an Endotracheal Tube with Polyurethane Cuff and Subglottic Secretion Drainage on Pneumonia.American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 1079-1083, (2007)

而許多機構已經將此一概念寫入指南：

Guidelines and Recommendations

Based on the available evidence, the following organizations recommend use of CASS to reduce the incidence of ventilator-associated pneumonia:

• American Thoracic Society/ Infectious Diseases Society of America (ATS/IDSA) – Level I¹⁴
• Centers for Disease Control (CDC) – Category II¹⁵
• American Association of Critical Care Nurses (AACN)¹⁶
• Agency for Healthcare Research and Quality (AHRQ)¹⁷

14.Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and
Healthcare-associated Pneumonia. American Journal of Respiratory Critical Care Medicine. 2005;171:388-416.
15.Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. March 26, 2004/53(RR03);1-36.
16.American Association of Critical Care Nurses. Practice Alert: Ventilator-Associated Pneumonia. 2004.
17.Shojania KG, Duncan BW, McDonald KM, et al. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/ Technology Assessment No. 43 (Prepared by the University of California at San Francisco–Stanford Evidence-based Practice Center under Contract No. 290-97-0013), AHRQ Publication No. 01-E058, Rockville, MD: Agency for Healthcare Research and Quality. July 2001.

麻醉中發生的吸入性肺炎aspiration pneumonitis為1/3000，死亡率在8~10%。而另一種吸入性肺炎，VAP Ventilator associated pneumonia是加護病房內常見的照護併發症之一，吸入口咽腔內的細菌則是主要的病源。麻醉中的併發症若是除外高危險群病患(abdominal distension GI disorder, intestine ileus or obstruction etc)，則發生率應該小於1/3000，因此此種新型的氣管內管應該會局限於高危險患者與加護病房插管病患。

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