Tracheal tubes intracuff pressure difference between neutral head-neck position and lateral rotation in patients with tracheal intubation

Abstract

BackgroundTracheal tubes (TT) cuffs seal the airway to facilitate positive pressure ventilation and prevent aspiration due to subglottic secretions. Changes in head-neck position can affect TT intracuff pressure. An increase or decrease in TT intracuff pressure can cause many morbidities. The purpose of this study was to determine the effect of lateral head-neck rotation on TT intracuff pressure. MethodsForty (40) patients aged 18–64 years undergoing elective surgery under general anesthesia were selected in this study. After tracheal intubation, the TT cuff was inflated with a minimal occlusive volume technique. The TT was placed on the right side of the mouth. Changes in TT intracuff pressure were assessed before and after the position change. TT intracuff pressure was measured with a cuff inflator in the neutral head position. After lateral head-neck rotation (60°), the intracuff pressure was remeasured. ResultsThe mean intracuff pressure increased from 25.5 + 1.64 to 29.4 + 1.71 cmH2O after lateral head-neck rotation (p = 0.000). There was a significant difference between neutral position and lateral head rotation (p < 0.05). The use of a minimal occlusive volume technique with a volume of 4–7 cc was able to produce TT intracuff pressure between 22 and 28 cmH2O (normal range 20–30 cmH2O). The difference in TT intracuff pressure after lateral head-neck rotation was 3.9 ± 1.31 cmHO2. ConclusionTracheal tube intracuff pressure is significantly higher after the head-neck position change from neutral to lateral rotation. Measurement of intracuff pressure after lateral head rotation is beneficial to avoid possible adverse effects of position-related pressure changes.