The Changes of Cuff Pressure from Endotracheal Intubation for Long-term Mechanical Ventilation

Abstract

Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure () of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low . To prevent these complications, the should be kept appropriately because the appropriate appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume() has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal instead of monitoring the directly at the patients' bedside. To address the necessity of continuous monitoring, the change in the was evaluated at various levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring was also investigated. Method: The change in according to the increase in was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in daily during the mechanical ventilation days. In addition, the measured by mercury column sphygmomanometer was compared with the measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of during more than 14 days of intubation for mechanical ventilation. However the required to maintain the appropriate varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the was observed from 10 to 46 at constant 3 cc . The measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the to maintain the appropriate level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.