Does cost affect endotracheal tube performance?

Introduction

Today's healthcare environment has forced providers to constantly evaluate the materials used, and to find less expensive alternatives. Recently, low-cost endotracheal tubes (ETTs) have been introduced to the market. The aim of this study was to test these tubes (Portex AirCare and Cardinal Health ETT) compared with endotracheal tubes with known performance (Hi-Lo Covidient pre ISO standard and Taper-Guard Covidient, post ISO standard).

Methods

We used the required test setups according to the ISO standard for cuff sealing performance. The tubes were tested versus each other in size 7.0, 7.5 and 8.0 mm. Kink performance was done in the routine manner.

Results

The leak test showed that the Portex AirCare ETT leaked significantly more compared with both the Hi-Lo (P < 0.05) or Taper- Guard (P < 0.001) ETTs. The standard deviation leak rate for AirCare was large, suggesting varying seal performance between tubes from various lots. The kink test showed no difference among tubes.

Conclusion

Although tubes look the same there may be differences in performance. This study demonstrated that the new cheaper ETTs had greater cuff leak compared with the two tubes used for comparison. We can only speculate whether differences found in this study is a result of cost cutting. However, the great variability in sealing performance between ETTs of the same size from different lots would indicate that manufacturing controls may be less stringent. Although we cannot demonstrate that the higher incidence of leak will result in adverse patient outcomes, one can surmise that the possibility exists. Thus, selection of endotracheal tubes should not be based on purchase price alone but should take into account documented performance in standardized tests.