Reduced Endotracheal Tube Cuff Pressure to Assess Dysphagia After Anterior Cervical Spine Surgery.

Abstract

This was a prospective, randomized control pilot study. The aim of this study was to determine whether continuous monitoring and adjustment of the endotracheal tube cuff pressure (ETTCP) to 15 mm Hg during ACSS would alter the incidence of postoperative dysphagia. Postoperative dysphagia is a recognized potential complication of anterior cervical spine surgery (ACSS). Recent findings on preventive measures suggest that certain intraoperative practices may minimize this complication. Fifty patients undergoing ACSS, arthroplasty, or fusion, completed routine lateral cervical preoperative plain films and questionnaires [Dysphagia Disability Index (DDI), Bazaz-Yoo Dysphagia Score (BYDS), and Short Form (36) Health Survey]. Patients were randomized into 2 groups: treatment group with ETTCP maintained at 15 mm Hg and control group with cuff pressure monitored without manipulation. Radiographs and questionnaires were obtained at 24 hours, 6 weeks, and 3 and 6 months postsurgery to assess soft tissue thickness and rates of dysphagia. There were no significant differences between the groups in the soft tissue thickness or questionnaire scores at any timepoint (P>0.05). Within-group analysis revealed treatment and control groups had a significantly higher 24-hour postoperative soft tissue thickness and questionnaire scores compared with follow-up measurements (P<0.05). In the pooled group (n=50), the 24-hour postoperative DDI, BYDS, and soft tissue thickness were significantly higher compared with all other timepoints (P<0.01). DDI scores ≥10 related to dysphagia were in 59% of patients at 24 hours, 35% at 6 weeks, 24% at 3 months, and 18% at 6 months. This study suggests decreased ETTCP has no effect on the prevalence of dysphagia. The incidence of dysphagia decreases over time and normalizes by 6 months postsurgery.