Bronchial blockers under pressure: In vitro model and ex vivo model

Abstract

Background Pressures (Pe) exerted by bronchial blockers on the inner wall of the bronchi may cause mucosal ischaemia. Our aims were as follows: (i) to compare the intracuff pressure (Pi) and Pe exerted by commercially available bronchial blockers in an in vitro and an ex vivo model; (ii) to investigate the influence of both the inflated intracuff volume and cuff diameter on Pe; and (iii) to estimate the minimal sealing volume (VSmin) and the corresponding Pe for each bronchial blocker studied. Methods The Pe exerted by seven commercial bronchial blockers was measured at different inflation volumes using a custom-designed system using in vitro and ex vivo animal models with two internal diameters (12 and 15 mm). Results In the same conditions, Pi was significantly lower than Pe (P<0.05), and Pe was higher in the in vitro model than in the ex vivo model. The Pe increased with the inflated volume, with use of the small-diameter model (P<0.05). Ex vivo models needed a higher minimal sealing volume than the in vitro models, and this volume increased with the diameter (e.g. the VSmin at a positive pressure of 25 cm H2O required a Pe ranging from 12 to 78 mm Hg on the 15 mm ex vivo model and from 66 to 110 mm Hg on the 12 mm ex vivo model). Conclusions The Pi cannot be used to approximate Pe. The diameter of the model, the inflated volume, and the bronchial blocker design all influence Pe. A pressure higher than the critical ischaemic threshold (i.e. 25 mm Hg) was needed to prevent air leak around the cuff in the in vitro and ex vivo models.