Endotracheal Tube Cuff Pressure Changes Research Articles

Observational Analysis of Endotracheal Tube Cuff Pressure Changes during Laparoscopic Surgery in Trendelenburg and Reverse Trendelenburg Position

Observational Analysis of Endotracheal Tube Cuff Pressure Changes during Laparoscopic Surgery in Trendelenburg and Reverse Trendelenburg Position

A comparative study of endotracheal tube cuff pressure changes in patients undergoing open abdominal and laparoscopic surgeries

Background: Laparoscopic surgeries are routinely performed because it’s minimally invasive and early recovery for patients. The preferred mode of anesthesia is general anesthesia with an endotracheal tube (ETT). The creation of the pneumoperitoneum and various positions cause cuff pressure (CP) changes. Aims and Objectives: We aim to study the CP changes and post-operative complications related to it. The secondary objective was to observe the post-operative complications such as sore throat, hoarseness of voice, and blood-streaked expectoration after extubation at 12 h, and at the time of discharge from the post-anesthesia care unit. Materials and Methods: One hundred and fifty patients undergoing elective open abdominal and laparoscopic surgeries were enrolled. Three groups (open abdominal [group A], n=50; lap head up [group B], n=50; and lap head down [group C], n=50) were compared for CP changes before and after pneumoperitoneum and position change. CP changes and post-operative complications were recorded and analyzed with Statistical Package for the Social Sciences version 19. Results: Mean differences in CP after intubation at 5 min were similar in all three groups. At 45 min onward, the mean CP in group C was found to be elevated and continued to increase till the end of surgery. However, at 90 min, group B also showed some increase in CP. There was a mild increase in CP in groups B and A. The mean difference between groups was found to be remarkable. During the post-operative period, there were 0.7% and 3.3% of cases with throat pain in group B and group C, and 2% of patients in group C had blood streak expectoration. Conclusion: In laparoscopic surgery, especially in a head-down position, a considerable increase in CP is associated with postoperative complications.

Evaluation of the endotracheal tube cuff pressure changes during cardiac operations under cardiopulmonary bypass.

Introduction: Tracheal intubation is used for most operations under general anesthesia. Prolonged hyperinflation of the tube cuff can compromise tracheal mucosal perfusion, and low pressure of the cuff may cause some other complications. The aim of this study was the evaluation of changes in intra-cuff pressure in patients undergoing cardiac surgeries under cardiopulmonary bypass. Methods: In an observational study 120 patient's candidate to cardiac operations under cardiopulmonary bypass were enrolled. After induction of anesthesia and tracheal intubation by same tracheal tubes, tracheal tube cuff pressure was adjusted to 20-25 mm Hg (T0). Then the cuff pressure was measured at beginning of CPB (Cardio Pulmonary Bypass) (T1), at 30º hypothermia (T2) and after separation from CPB (T3). Results: The mean cuff pressure was 33.5±7.3, 28.9±5.4, 25.6±5.2 and 28.1±3.7 at T0, T1, T2 and T3 respectively. Intra- cuff pressure changed significantly during cardiopulmonary bypass. Conclusion: The mean intra-cuff pressure was decreased during hypothermic cardiopulmonary bypass. The decrease in cuff pressure may protect the tracheal mucosa against hypotensive ischemic injury in these patients.

Endotracheal tube cuff pressure changes with pneumoperitoneum and steep head down position in patients undergoing robotic urogynecological surgeries – A prospective observational study

Background: The abdominal insufflation in the laparoscopic surgery has been reported to result in an increase in endotracheal tube (ETT) cuff pressure (Pcuff). However, the effect of Trendelenburg, lithotomy and pneumoperitoneum on the ETT Pcuff in robotic urogynaecology surgeries are not well established. Aim: Analyse the changes in ETT cuff pressure during robotic urognaecological surgery. Primary Objective: 1. The changes in ETT cuff pressure after creation of pneumoperitoneum. 2. The changes in ETT cuff pressure after change in position of the patient. Secondary Objectives: 1. To correlate the changes in ETT cuff pressure with airway pressure. 2. To correlate the changes in ETT cuff pressure with BMI. Methods: Sixty patients undergoing elective robotic urogynaecology surgeries were enrolled in the study. ETT Pcuff during different time points was measured and analysed. Also, the change in ETT Pcuff was correlated with the airway pressure (Paw). Results: The difference in ETT Pcuff, before and after lithotomy, pneumoperitoneum and the Trendelenburg position were 1.1 ± 0.7 cmH2O, 4.6 ± 1.0 cmH2O and 1.8 ± 0.8 cmH2O respectively and were statistically significant (probability: P < 0.05). Results obtained after reversing patient position from Trendelenburg position to supine, abdominal deflation and from lithotomy to supine respectively were -2.2 ± 1.4 cmH2O, -4.1 ± 1.0 cmH2O and -0.4 ± 0.8 cmH2O respectively (P < 0.05). The Karl Pearson coefficient of correlation (r) between Pcuff and Paw after lithotomy, pneumoperitoneum, and Trendelenburg position respectively were 0.606, 0.661 and 0.309. Freidman's nonparametric repeated-measures analysis of variance (ANOVA) was used to analyze differences between related Pcuff values over different time points. Overall P value was significant (P < 0.00001). Conclusion: An increase in ETT cuff pressure is seen in robotic laparoscopic surgeries after abdominal insufflation, Trendelenburg position and lithotomy position.

Endotracheal Tube Intracuff Pressure Changes in Patients Transported by a Helicopter Emergency Medical Service: A Prospective Observational Study

ObjectiveThe pressure within an endotracheal tube cuff is of particular importance in helicopter emergency medical services (HEMS) transport because the unpressurized cabin is subjected to decreases in atmospheric pressure. This can cause the cuff to overinflate and may be associated with clinical complications. We sought to evaluate endotracheal tube cuff pressure changes among intubated patients during HEMS transport. MethodsA prospective observational study was performed including adult patients who were intubated and transported by helicopter between April 2017 and October 2018. Cuff pressures were measured before, during, and after HEMS transport with a commercial manometer. ResultsA total of 208 patients were included. The median maximum flight altitude was 3,000 (interquartile range [IQR], 2,000-5,000) ft. The median initial cuff pressure before takeoff was 35 (IQR, 24-50) cm H2O, which increased to 50 (IQR, 35-70) cm H2O at maximum altitude. A total of 169 (81.3%) patients had a cuff pressure > 30 cm H2O at maximum altitude. There was a moderate correlation between altitude and cuff pressure (r = 0.532, P < .001). ConclusionsCuff pressure increased during HEMS transport, demonstrating the need for routine cuff pressure monitoring during flight. Further research is required to determine if exposure to transient increases in cuff pressure for short durations is clinically significant.

A Comparative Study on the Endotracheal Tube Cuff Pressure Changes between Supine and Prone in Patients Undergoing Prone Position Surgerie

A Comparative Study on the Endotracheal Tube Cuff Pressure Changes between Supine and Prone in Patients Undergoing Prone Position Surgerie

Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in-vitro assessment.

Endotracheal tube (ETT) cuffs are designed to seal the lower airway for precise ventilation and to protect against ingress of pathogens from the pharyngeal space. Therefore, a minimal continuous cuff pressure must be maintained. Aim of this study was to analyse the course of cuff pressure in an in-vitro model during manual cuff pressure control manoeuvres. An artificial trachea was intubated with an appropriately sized ETT and cuff pressure set to 20 cm H2 O. Thirty-two experienced ICU nurses each performed six cuff pressure control manoeuvres (three times in two different ETTs) using a manual cuff pressure manometer. Course of cuff pressure from connecting the manometer to disconnecting it from the cuff pilot balloon was recorded using a pressure transducer. There were 190 cuff pressure control manoeuvres suitable for analysis. In all control manoeuvres a cuff pressure below 20 cm H2 O was noted. In 20.0% of the control manoeuvres the cuff pressure dropped below 10 cm H2 O. Cuff pressure drops were mainly caused by initially connecting the manometer to the pilot balloon, less frequently by manipulating the pressure gauge of the manometer. Disconnecting the manometer after the control manoeuvre caused a cuff pressure drop in 78.1% of cases, contributing to a final cuff pressure below 20 cm H2 O in 31.3% of control manoeuvres. Routine manual cuff pressure control manoeuvres in ETT cuffs result in considerable cuff pressure drops. This may have an impact on silent aspiration of pharyngeal contents passing along the cuff into the lower airway.

Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in anesthetic gases during laparoscopic abdominal surgeries

The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in anesthetic gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. Total 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n=50) received air while Group N (n=50) received nitrous-oxide in anesthetic gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30min, 60min and 90min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24h after extubation. Cuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p<0.001). Within Group A, cuff pressure increased more at 90min than at 30min (p<0.05). Within Group N, increase in cuff pressure was more at each time point (30, 60 and 90min) than its previous time point (p<0.05). The incidence of sore throat in post-anesthesia care unit was higher in Group N than in Group A. Use of nitrous-oxide during laparoscopy increases cuff pressure resulting in increased incidence of postoperative sore throat. Cuff pressure should be monitored routinely during laparoscopy with nitrous-oxide anesthesia.

Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in anesthetic gases during laparoscopic abdominal surgeries

Background and objectivesThe purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in anesthetic gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. MethodsTotal 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n=50) received air while Group N (n=50) received nitrous-oxide in anesthetic gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30min, 60min and 90min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24h after extubation. ResultsCuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p<0.001). Within Group A, cuff pressure increased more at 90min than at 30min (p<0.05). Within Group N, increase in cuff pressure was more at each time point (30, 60 and 90min) than its previous time point (p<0.05). The incidence of sore throat in post-anesthesia care unit was higher in Group N than in Group A. ConclusionUse of nitrous-oxide during laparoscopy increases cuff pressure resulting in increased incidence of postoperative sore throat. Cuff pressure should be monitored routinely during laparoscopy with nitrous-oxide anesthesia.