Introduction: Appropriate seal of airway management devices is a crucial factor during ventilatory support in critically ill patients. The presence of a leak during ventilation is associated with worse patient outcomes. This study aims to evaluate the level of seal of advanced airway management devices during mechanical ventilation in a manikin model. Methods: Advanced airway management devices, such as an orotracheal tube, a laryngeal mask 1st generation, a laryngeal tube, and an i-Gel, were placed in the manikin simulator Code Blue® III Adult with OMNI® (Gaumard). Ventilatory support was delivered through the Ventway Sparrow mechanical ventilator at predefined ventilatory settings across all devices for ten minutes. Results: Ten device placements were conducted for each one. The manikin provided feedback on achieving the target volume set during ventilatory support across all evaluated devices. For the analysis, a total of 1200 ventilations in each device were evaluated. Target volume achievement for orotracheal tube was 100%; for laryngeal mask 1st generation was 74% (95% CI: 65-83%); for laryngeal tube was 83% (95% CI: 80-86%); and for i-Gel was 98% (95% CI: 96-100%). The level of leakage is inversely proportional to the level of compliance with the target volume. While the endotracheal tube remains the gold standard for target volume achievement and to avoid leaks, i-Gel seems to be an appropriate option until definitive airway management placement. Conclusion: Results suggest a wide variability of seal level between different airway management devices. Endotracheal tubes stand out as the gold standard for an appropriate seal against the 1st generation laryngeal mask. However, the manikin study comprises several limitations; further studies are needed to compare the level of seal in real patients and its impact on patient mortality and complications.
Pinto-Villalba et al. (Sun,) studied this question.