Abstract
BackgroundTo prevent endotracheal tube (ETT)-related complications during mechanical ventilation, ETT cuff pressure should be kept within proper range. In clinical settings, cuff pressure often decreases from target values.MethodsWe performed an experimental study to investigate the effects of measuring devices and endotracheal tubes on change in cuff pressure. We continuously measured cuff pressure by inserting a three-way stopcock in the middle of an ETT pilot balloon system. After adjusting the cuff pressure to 24 cmH2O, we disconnected and reconnected each cuff inflator to the inflation valve of the ETT and measured the changes in the cuff pressure. We measured the change in cuff pressure with different ETT sizes, cuff shapes, brands of cuff inflator, and with and without added extension tubes.ResultsThe cuff pressure decreased, on average, by 6.6 cmH2O (standard deviation 1.9), when connecting the cuff inflator to the pilot balloon. The measured cuff pressure was less than 20 cmH2O in 67% of the tests. The cuff pressure decreased more when an extension tube was used. The brand of cuff inflator made no difference to the pressure loss. The cuff pressure decreased more with ETTs of smaller size and with ETTs with pyriform cuffs.ConclusionsProcedures to connect cuff inflators to inflation valves resulted in the loss of cuff pressure by 6.6 cmH2O on average.
Highlights
To prevent endotracheal tube (ETT)-related complications during mechanical ventilation, ETT cuff pressure should be kept within proper range
Because the manufacturer's manual recommended an addition of an extension tube during cuff pressure measurement, we evaluated the effects of the extension tube which was placed between the pilot cuff and the cuff inflator
The cuff pressure decreased by 6.6 ± 1.9 cmH2O on average with and without extension tubes, when reconnecting the cuff inflator to the pilot balloon
Summary
To prevent endotracheal tube (ETT)-related complications during mechanical ventilation, ETT cuff pressure should be kept within proper range. An endotracheal tube (ETT) with a cuff is commonly used during invasive mechanical ventilation. It is recommended to maintain cuff pressure within 20–30 cmH2O [1,2,3,4]. Excessive cuff pressure increases the risk of tracheal injury and stenosis, and insufficient cuff pressure can result in air leakage, aspiration, and unplanned extubation [4]. A procedure to maintain cuff pressure at appropriate range may reduce cuff leak, aspiration, and tracheal injury. We failed to prevent changes in cuff pressure in critically ill patients [6], and we wondered if there might be a problem related to the measurement procedure. To test a hypothesis that the action of measuring cuff pressure contributed to the loss of pressure, we
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