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Critical Care (London, England) Jun 2016When conventional high-volume, low-pressure cuffs of endotracheal tubes (ETTs) are inflated, channel formation due to folds in the cuff wall can occur. These channels... (Review)
Review
BACKGROUND
When conventional high-volume, low-pressure cuffs of endotracheal tubes (ETTs) are inflated, channel formation due to folds in the cuff wall can occur. These channels facilitate microaspiration of subglottic secretions, which is the main pathogenic mechanism leading to intubation-related pneumonia. Ultrathin polyurethane (PU)-cuffed ETTs are developed to minimize channel formation in the cuff wall and therefore the risk of microaspiration and respiratory infections.
METHODS
We systematically reviewed the available literature for laboratory and clinical studies comparing fluid leakage or microaspiration and/or rates of respiratory infections between ETTs with polyvinyl chloride (PVC) cuffs and ETTs with PU cuffs.
RESULTS
The literature search revealed nine in vitro experiments, one in vivo (animal) experiment, and five clinical studies. Among the 9 in vitro studies, 10 types of PU-cuffed ETTs were compared with 17 types of PVC-cuffed tubes, accounting for 67 vs. 108 experiments with 36 PU-cuffed tubes and 42 PVC-cuffed tubes, respectively. Among the clinical studies, three randomized controlled trials (RCTs) were identified that involved 708 patients. In this review, we provide evidence that PU cuffs protect more efficiently than PVC cuffs against fluid leakage or microaspiration. All studies with leakage and/or microaspiration as the primary outcome demonstrated significantly less leakage (eight in vitro and two clinical studies) or at least a tendency toward more efficient sealing (one in vivo animal experiment). In particular, high-risk patients intubated for shorter periods may benefit from the more effective sealing capacity afforded by PU cuffs. For example, cardiac surgery patients experienced a lower risk of early postoperative pneumonia in one RCT. The evidence that PU-cuffed tubes prevent ventilator-associated pneumonia (VAP) is less robust, probably because microaspiration is postponed rather than eliminated. One RCT demonstrated no difference in VAP risk between patients intubated with either PU-cuffed or PVC-cuffed tubes, and one before-after trial demonstrated a favorable reduction in VAP rates following the introduction of PU-cuffed tubes.
CONCLUSIONS
Current evidence can support the use of PU-cuffed ETTs in high-risk surgical patients, while there is only very limited evidence that PU cuffs prevent pneumonia in patients ventilated for prolonged periods.
Topics: Equipment Design; Humans; Intubation, Intratracheal; Pneumonia, Ventilator-Associated; Polyurethanes; Respiration, Artificial
PubMed: 27342802
DOI: 10.1186/s13054-016-1380-8 -
Molecules (Basel, Switzerland) Dec 2019In this study, microcellular polyurethane (PU)-natural fiber (NF) biocomposites were fabricated. Polyurethanes based on castor oil and PMDI were synthesized with varying...
In this study, microcellular polyurethane (PU)-natural fiber (NF) biocomposites were fabricated. Polyurethanes based on castor oil and PMDI were synthesized with varying volume ratios of sisal fiber. The effect of natural fiber treatment using water and alkaline solution (1.5% NaOH) and load effect were investigated. Biocomposites were mechanically and physically investigated using tensile, viscoelasticity, and water absorption tests. The interfacial adhesion between PU and sisal fiber was studied using SEM. Short NF loads (3%) showed a significant improvement in the mechanical properties of the PU-sisal composite such as modulus of elasticity, yield and tensile strength up to 133%, 14.35 % and 36.7% respectively. Viscoelastic measurements showed that the composites exhibit an elastic trend as the real compliance (J') values were higher than those of the imaginary compliance (J''). Increasing NF loads resulted in a decrease of J'. Applying variable temperatures (120-80 °C) caused an increase in the stiffness at different frequencies.
Topics: Elastic Modulus; Materials Testing; Molecular Structure; Polyurethanes; Rheology; Temperature; Tensile Strength; Textiles
PubMed: 31847377
DOI: 10.3390/molecules24244585 -
Scientific Reports Jul 2022Biomaterial-associated infections are a major healthcare challenge as they are responsible for high disease burden in critically ill patients. In this study, we have...
Biomaterial-associated infections are a major healthcare challenge as they are responsible for high disease burden in critically ill patients. In this study, we have developed drug-eluting antibacterial catheters to prevent catheter-related infections. Niclosamide (NIC), originally an antiparasitic drug, was incorporated into the polymeric matrix of thermoplastic polyurethane (TPU) via solvent casting, and catheters were fabricated using hot-melt extrusion technology. The mechanical and physicochemical properties of TPU polymers loaded with NIC were studied. NIC was released in a sustained manner from the catheters and exhibited in vitro antibacterial activity against Staphylococcus aureus and Staphylococcus epidermidis. Moreover, the antibacterial efficacy of NIC-loaded catheters was validated in an in vivo biomaterial-associated infection model using a methicillin-susceptible and methicillin-resistant strain of S. aureus. The released NIC from the produced catheters reduced bacterial colonization of the catheter as well as of the surrounding tissue. In summary, the NIC-releasing hot-melt extruded catheters prevented implant colonization and reduced the bacterial colonization of peri-catheter tissue by methicillin sensitive as well as resistant S. aureus in a biomaterial-associated infection mouse model and has good prospects for preclinical development.
Topics: Animals; Anti-Bacterial Agents; Biocompatible Materials; Catheters; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mice; Niclosamide; Polyurethanes; Staphylococcal Infections; Staphylococcus aureus
PubMed: 35854044
DOI: 10.1038/s41598-022-16107-4 -
CMAJ : Canadian Medical Association... Aug 2022
Topics: Adhesives; Alveolitis, Extrinsic Allergic; Humans; Occupational Diseases; Occupational Exposure; Polyurethanes
PubMed: 35918092
DOI: 10.1503/cmaj.220052 -
Biosensors Jun 2023Polyion complex (PIC) materials have been widely used in biosensors due to their molecular selectivity. However, achieving both widely controllable molecular selectivity...
Polyion complex (PIC) materials have been widely used in biosensors due to their molecular selectivity. However, achieving both widely controllable molecular selectivity and long-term solution stability with traditional PIC materials has been challenging due to the different molecular structures of polycations (poly-C) and polyanions (poly-A). To address this issue, we propose a novel polyurethane (PU)-based PIC material in which the main chains of both poly-A and poly-C are composed of PU structures. In this study, we electrochemically detect dopamine (DA) as the analyte and L-ascorbic acid (AA) and uric acid (UA) as the interferents to evaluate the selective property of our material. The results show that AA and UA are significantly eliminated, while DA can be detected with a high sensitivity and selectivity. Moreover, we successfully tune the sensitivity and selectivity by changing the poly-A and poly-C ratios and adding nonionic polyurethane. These excellent results were employed in the development of a highly selective DA biosensor with a detection range from 500 nM to 100 μM and a 3.4 μM detection limit. Overall, our novel PIC-modified electrode has the potential to advance biosensing technologies for molecular detection.
Topics: Dopamine; Polyurethanes; Electrodes; Ascorbic Acid; Uric Acid; Biosensing Techniques; Electrochemical Techniques
PubMed: 37367003
DOI: 10.3390/bios13060638 -
Scientific Reports May 2022A strain sensor characterized by elasticity has recently been studied in various ways to be applied to monitoring humans or robots. Here, 4 types of 3D-printed auxetic...
A strain sensor characterized by elasticity has recently been studied in various ways to be applied to monitoring humans or robots. Here, 4 types of 3D-printed auxetic lattice structures using thermoplastic polyurethane as raw material were characterized: truss and honeycomb with positive Poisson's ratio and chiral truss and re-entrant with negative Poisson's ratio. Each structure was fabricated as a flexible and stable strain sensor by coating graphene through a dip-coating process. The fabricated auxetic structures have excellent strength, flexibility, and electrical conductivity desirable for a strain sensor and detect a constant change in resistance at a given strain. The 3D-printed auxetic lattice 4 type structures coated with CWPU/Graphene suggest potential applications of multifunctional strain sensors under deformation.
Topics: Elasticity; Electric Conductivity; Graphite; Humans; Polyurethanes; Printing, Three-Dimensional
PubMed: 35546596
DOI: 10.1038/s41598-022-11540-x -
International Journal of Molecular... Nov 2021This study concerns bio-based urethane prepolymers. The relationship between the chemical structure and the thermal and processing parameters of bio-based...
This study concerns bio-based urethane prepolymers. The relationship between the chemical structure and the thermal and processing parameters of bio-based isocyanate-terminated ether and ester-urethane prepolymers was investigated. Bio-based prepolymers were obtained with the use of bio-monomers such as bio-based diisocyanate, bio-based polyether polyol or polyester polyols. In addition to their composition, the bio-based prepolymers were different in the content of iso-cyanate groups content (ca. 6 and 8%). The process of pre-polymerization and the obtained bio-based prepolymers were analyzed by determining the content of unreacted NCO groups, Fourier transform infrared spectroscopy, proton nuclear magnetic resonance, thermogravimetry, and rheological measurements. The research conducted facilitated the evaluation of the properties and processability of urethane prepolymers based on natural components. The results indicate that a significant impact on the processability has the origin the polyol ingredient as well as the NCO content. The thermal stability of all of the prepolymers is similar. A prepolymer based on a poly-ether polyol is characterized by a lower viscosity at a lower temperature than the prepolymer based on a polyester polyol. The viscosity value depends on the NCO content.
Topics: Esters; Ether; Molecular Weight; Polyesters; Polymerization; Polymers; Polyurethanes; Surface Properties
PubMed: 34830089
DOI: 10.3390/ijms222212207 -
Scientific Reports May 2024Repair and reconstruction of the myopectineal orifice area using meshes is the mainstay of surgical treatment of inguinal hernias. However, the limitations of existing...
Repair and reconstruction of the myopectineal orifice area using meshes is the mainstay of surgical treatment of inguinal hernias. However, the limitations of existing meshes are becoming increasingly evident in clinical applications; thus, the idea of using three-dimensionally (3D)-printed biological meshes was put forward. According to the current level of the 3D printing technology and the inherent characteristics of biological materials, the direct use of the 3D printing technology for making biological materials into finished products suitable for clinical applications is not yet supported, but synthetic materials can be first printed into 3D form carriers, compounded with biological materials, and finally made into finished products. The purpose of this study was to develop a technical protocol for making 3D-printed biomesh carriers using polyurethane as a raw material. In our study: raw material, polyurethane; weight, 20-30 g/m; weaving method, hexagonal mesh; elastic tension aspect ratio, 2:1; diameters of pores, 0.1-1 mm; surface area, 8 × 12 cm; the optimal printing layer height, temperature and velocity were 0.1 mm, 210-220 °C and 60 mm/s. Its clinical significance lies in: (1) applied to preoperative planning and design a detailed surgical plan; (2) applied to special types of surgery including patients in puberty, recurrent and compound inguinal hernias; (3) significantly improve the efficiency of doctor-patient communication; (4) it can shorten the operation and recovery period by about 1/3 and can save about 1/4 of the cost for patients; (5) the learning curve is significantly shortened, which is conducive to the cultivation of reserve talents.
Topics: Printing, Three-Dimensional; Polyurethanes; Surgical Mesh; Humans; Hernia, Inguinal; Biocompatible Materials; Herniorrhaphy; Materials Testing
PubMed: 38806559
DOI: 10.1038/s41598-024-63000-3 -
Advanced Science (Weinheim,... Mar 2024Flexible electronic sensors are receiving numerous research interests for their potential in electronic skins (e-skins), wearable human-machine interfacing, and smart...
Flexible electronic sensors are receiving numerous research interests for their potential in electronic skins (e-skins), wearable human-machine interfacing, and smart diagnostic healthcare sensing. However, the preparation of multifunctional flexible electronics with high sensitivity, broad sensing range, fast response, efficient healability, and reliable antibacterial capability is still a substantial challenge. Herein, bioinspired by the highly sensitive human skin microstructure (protective epidermis/spinous sensing structure/nerve conduction network), a skin bionic multifunctional electronics is prepared by face-to-face assembly of a newly prepared healable, recyclable, and antibacterial polyurethane elastomer matrix with conductive MXene nanosheets-coated microdome array after ingenious templating method as protective epidermis layer/sensing layer, and an interdigitated electrode as signal transmission layer. The polyurethane elastomer matrix functionalized with triple dynamic bonds (reversible hydrogen bonds, oxime carbamate bonds, and copper (II) ion coordination bonds) is newly prepared, demonstrating excellent healability with highly healing efficiency, robust recyclability, and reliable antibacterial capability, as well as good biocompatibility. Benefiting from the superior mechanical performance of the polyurethane elastomer matrix and the unique skin bionic microstructure of the sensor, the as-assembled flexible electronics exhibit admirable sensing performances featuring ultrahigh sensitivity (up to 1573.05 kPa ), broad sensing range (up to 325 kPa), good reproducibility, the fast response time (≈4 ms), and low detection limit (≈0.98 Pa) in diagnostic human healthcare monitoring, excellent healability, and reliable antibacterial performance.
Topics: Humans; Polyurethanes; Reproducibility of Results; Electronics; Anti-Bacterial Agents; Elastomers
PubMed: 38140748
DOI: 10.1002/advs.202305672 -
Acta Biomaterialia Jan 2020Congenital heart defects affect about 1% births in the United States. Many of the defects are treated with surgically implanted patches made from inactive materials or...
Congenital heart defects affect about 1% births in the United States. Many of the defects are treated with surgically implanted patches made from inactive materials or fixed pericardium that do not grow with the patients, leading to an increased risk of arrhythmia, sudden cardiac death, and heart failure. This study investigated an angiogenic poly(ethylene glycol) fibrin-based hydrogel reinforced with an electrospun biodegradable poly(ether ester urethane) urea (BPUR) mesh layer that was designed to encourage cell invasion, angiogenesis, and regenerative remodeling in the repair of an artificial defect created onto the rat right ventricle wall. Electrocardiogram signals were analyzed, heart function was measured, and fibrosis, macrophage infiltration, muscularization, vascularization, and defect size were evaluated at 4- and 8-weeks post-surgery. Compared with rats with fixed pericardium patches, rats with BPUR-reinforced hydrogel patches had fewer arrhythmias and greater right ventricular ejection fraction and cardiac output, as well as greater left ventricular ejection fraction, fractional shorting, stroke work and cardiac output. Histology and immunofluorescence staining showed less fibrosis and less patch material remaining in rats with BPUR-reinforced hydrogel patches at 4- and 8-weeks. Rats with BPUR-reinforced hydrogel patches also had a greater volume of granular tissue, a greater volume of muscularized tissue, more blood vessels, and a greater number of leukocytes, pan-macrophages, and M2 macrophages at 8 weeks. Overall, this study demonstrated that the engineered BPUR-reinforced hydrogel patch initiated greater regenerative vascular and muscular remodeling with a limited fibrotic response, resulting in fewer incidences of arrhythmia and improved heart function compared with fixed pericardium patches when applied to heal the defects created on the rat right ventricle wall. STATEMENT OF SIGNIFICANCE: The study tested a polyurethane-reinforced hydrogel patch in a rat right ventricle wall replacement model. Compared with fixed pericardium patches, these reinforced hydrogel patches initiated greater regenerative vascular and muscular remodeling with a reduced fibrotic response, resulting in fewer incidences of arrhythmia and improved heart function at 4- and 8-weeks post surgery. Overall, the new BPUR-reinforced hydrogel patches resulted in better heart function when replacing contractile myocardium than fixed pericardium patches.
Topics: Animals; Cardiac Output; Electrocardiography; Heart Ventricles; Heart-Assist Devices; Hydrogels; Male; Myocardium; Polyurethanes; Rats; Rats, Sprague-Dawley; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31654774
DOI: 10.1016/j.actbio.2019.10.026