Abstract
BackgroundPrevious investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself. However is not established in literature if this loss of CP is able to generate alterations on expired tidal volume (ETV). Therefore, the aim of this study was to evaluate the potential consequences of the endotracheal CP assessment maneuver on CP levels and ETV in the early postoperative of coronary artery bypass grafting (CABG).MethodsA total of 488 patients were analyzed. After the operation, the lungs were ventilated in pressure-assist-control mode and the same ventilatory settings were adjusted for all patients. After intensive care unit arrival, the cuff was fully deflated and then progressively inflated by air injection, to promote a minimal volume to occlude the trachea. To assist the cuff inflation and the air leakage identification, the graphical monitoring of the volume-time curve was adopted. After 20 minutes a first cuff pressure evaluation was performed (P1) and a second measurement (P2) was taken after 20 minutes with an analog manometer. ETV was obtained always pre and post P1 measurement.ResultsThe CP assessment maneuver promoted a significant drop of P2 in relation to P1 when the manometer was attached to the pilot balloon (p < 0.0001). When compared the moments, pre-P1 versus post-P1, a significant drop of the ETV was also observed (p < 0.0001).ConclusionThe CP assessment maneuver promoted a significant decrease in CP values and occurrence of air leakage with reduction of ETV in the early postoperative of CABG.
Highlights
Previous investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself
The CP assessment maneuver promoted a significant drop of P2 in relation to P1 when the manometer was attached to the pilot balloon (p < 0.0001) (Table 2)
Pre-P1 versus post-P1, a significant drop of the expired tidal volume (ETV) was observed (p < 0.0001) (Table 3). In this prospective study, we evaluated potential consequences of manual CP measurement maneuver in own CP and ETV
Summary
Previous investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself. The main endotracheal tube (ETT) cuff function is to provide an adequate seal of the airway, preventing the air or fluids passage around the ETT. When this seal is compromised, aspirations of pharyngeal contents and poor ventilation may occur, favoring the respiratory complications appearance [1,2,3]. Previous investigations reported that the cuff pressure (CP) can vary and decrease over the time [4,5]. The frequent measurement can change the CP. The simple maneuver of connecting the pressure monometer to the inflating channel of the pilot balloon can cause a reduction of approximately 2 cmH2O in CP [7,8]
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