Advice

Summary

Summary

The TaperGuard Evac oral tracheal tube is intended for airway management in critically ill patients needing mechanical ventilation. Two randomised controlled trials comparing the use of TaperGuard Evac with conventional tubes found no statistically significant differences between the groups in the incidence of ventilator‑associated pneumonia, time to onset of ventilator‑associated pneumonia, or length of intensive care unit stay. Using TaperGuard Evac costs £111.07 (for a box of 10 single‑use tubes), plus a variety of accessories.

Product summary and likely place in therapy

  • The TaperGuard Evac oral tracheal tube is intended for airway management by oral intubation of the trachea and for evacuation or drainage of the subglottic space in critically ill patients needing mechanical ventilation.

  • It can be used in settings such as intensive therapy units (ITUs) or intensive care units (ICUs).

  • It has features that are intended to help prevent microaspiration, including an inflatable taper‑shaped cuff and subglottic secretion drainage.

  • It would be used in place of conventional oral tracheal tubes.

Effectiveness and safety

  • Two randomised controlled trials compared the TaperGuard Evac oral tracheal tube with conventional tubes for patients in ICU needing mechanical ventilation. One trial with 96 patients was published in full, and the other with 289 patients was published as a conference abstract only. Where reported, both trials found no statistically significant differences between the groups in incidence of ventilator‑associated pneumonia, time to ventilator‑associated pneumonia onset or length of ICU stay. Neither of these studies used the Automatic Pressure Controller that is recommended by the manufacturer to be used with the TaperGuard Evac oral tube.

  • One prospective controlled cohort study compared 4 subglottic secretion management interventions in 656 patients needing mechanical ventilation in an ICU. The incidence of ventilator‑associated respiratory infection was statistically significantly lower in the group treated with the TaperGuard Evac tube plus continuous control of cuff pressure, compared with groups treated with either the standard tube, or standard tube plus continuous control of cuff pressure. No other statistically significant change in the incidence of ventilator‑associated pneumonia was seen between the treatment groups.

Technical factors

  • The TaperGuard Evac oral tracheal tube is a single‑use endotracheal tube with a taper‑shaped cuff. The device has integrated subglottic secretion drainage through a separate evacuation lumen (termed 'Evac').

  • The tube incorporates a Magill curve, a tapered cuff with a cuff inflation valve, a suction port above the cuff with an evacuation lumen, a hooded tip with a Murphy Eye, and a radiopaque line to assist in radiographic visualisation. The TaperGuard Evac is recommended to be used with an Automatic Pressure Controller.

  • The TaperGuard Evac oral tracheal tube is supplied in a variety of sizes and lengths. The tube is made of polyvinyl chloride, is latex free and comes in sterile packaging. It is intended for oral intubation only.

Cost and resource use

  • A box of 10 single‑use TaperGuard Evac oral tracheal tubes costs £111.07.

  • A pressure cuff controller (£1000), suction pump (£700), disposable connecting tube (£20 for 10), non‑reusable reservoir (£55 for 10) and non‑reusable filter (£130 for 10) are recommended by the manufacturer for use with the TaperGuard Evac oral tracheal tube.

  • Alternative oral tracheal tubes range in price from £80.00 to £220.00 per box of 10 single‑use tubes.