Tube Cuff Research Articles

An innovative method of dilating tracheal stenosis by using endotracheal tube cuff inflation.

An innovative method of dilating tracheal stenosis by using endotracheal tube cuff inflation.

Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study.

Inflation of the endotracheal tube cuff is needed for providing ventilation. Cuff pressure should be maintained inside the appropriate range to prevent critical airway complications. The purpose of this study is to evaluate the pressure changes in the endotracheal tube cuff during otorhinolaryngologic surgery. This single-center observational study was conducted at Severance Hospital in Korea between April 2020 and November 2020. Patients aged >20 years scheduled to undergo otorhinolaryngological surgical procedures were enrolled. Patients undergoing planned tracheostomy and those who were slated for uncuffed endotracheal tube use were excluded. Intubation was performed after the induction of general anesthesia. A pressure transducer was connected to the pilot balloon of the endotracheal tube, and cuff pressure was continuously monitored until extubation. If the cuff pressure was not appropriate for more than 5 min, it was adjusted to the appropriate range by injecting or removing air. The percentage of time for which the cuff pressure remained within the appropriate range was calculated and defined as the time in the therapeutic range (TTR). The presumed cause for the rise or fall in cuff pressure was identified. In total 199 patients, alterations in cuff pressure outside the appropriate range occurred in 191 patients (96.0%). The mean TTR was 79.7% (SD 25.0%), and head and neck surgery had the lowest mean TTR of 69.0% compared to ear and nose surgeries (94.2 and 82.1%, respectively). Sixty-eight patients (34.2%) demonstrated inadequate endotracheal tube cuff pressure for more than 20% of the total anesthesia time. Twenty-six patients (13.1%) demonstrated optimal endotracheal tube cuff pressure for less than 50% of the total anesthesia time. The causative factors inducing inappropriate cuff pressure were found to vary, including positional changes, surgical procedure, anatomical manipulation, and anesthetic procedure. In otorhinolaryngologic surgery, cuff pressure increased or decreased outside the appropriate range due to various factors. Therefore, we suggest close continuous monitoring of cuff pressure during anesthesia for otorhinolaryngologic surgery. clinicaltrials.gov, identifier NCT03938493.

Measurement of tracheal tube cuff pressure and the incidence of postoperative sore throat

Measurement of tracheal tube cuff pressure and the incidence of postoperative sore throat

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: study protocol for a randomized controlled trial

BackgroundPostoperative sore throat (POST) is a common postoperative complication after endotracheal tube removal. There are still no effective preventive methods for POST. The aim of this trial is to confirm whether maintaining intraoperative cuff pressure below the tracheal capillary perfusion pressure could effectively reduce the incidence of POST among patients undergoing gynecological laparoscopic surgery.MethodsThis study is a single-center, randomized, parallel-controlled, superiority trial with a 1:1 allocation ratio. Sixty patients whose age is between 18 and 65 years and scheduled for gynecological laparoscopic surgery will be randomized to the cuff pressure measurement and adjustment (CPMA) group and the only cuff pressure measurement without adjustment group (control group). The primary endpoint is the incidence of sore throat at rest within 24 h after extubation. The secondary endpoints include the incidence of cough, the incidence of hoarseness, the incidence of postoperative nausea and vomiting (PONV), POST, and pain intensity within 24 h after extubation. Blocked randomization will be conducted with a computer-generated central randomization online service. The blind method will be applied to subjects, data collectors, outcome evaluators, and statisticians. Outcome assessments will be performed at 0 h and 24 h post-extubation.DiscussionThis randomized controlled study hypothesizes that cuff pressure is the primary influencing factor of POST. By continuous monitoring of endotracheal tube cuff pressure and maintaining it within the range of 18–22 mmHg compared with only continuous measurement without adjustment, it aims to prove that continuous measurement and adjustment of endotracheal tube cuff pressure could be effective in reducing the incidence of POST in gynecological laparoscopic surgery patients. The result of this study could be used as a reference for future multicenter studies to confirm the effect of cuff pressure on POST and provides a scientific theoretical basis for preventing POST to further support comfort medicine.Trial registrationChinese Clinical Trial Registry ChiCTR2200064792. Registered on 18 October 2022. This protocol (version 1.0, 16 March 2022) was approved by the Ethics Committee of Beijing Chaoyang Hospital.

Behavior of Endotracheal Tube Cuff Pressure During a Routine Control Maneuver With Different Manometers.

The main functions of the endotracheal tube (ETT) cuff are to prevent aspiration and to allow pressurization of the respiratory system. For this purpose, it is essential to maintain adequate pressure inside the cuff, thus reducing the risks for the patient. It is regularly checked using a manometer and is considered the best alternative. The objective of this study was to evaluate the cuff pressure behavior of different ETTs during the simulation of an inflation maneuver using different manometers. A bench study was performed. Four brands of 8-mm internal diameter single lumen with a Murphy eye ETT with cuff and 3 different brands of manometers were used. In addition, a pulmonary mechanics monitor was connected to the inside of the cuff through the body of the distal end of the ETT. A total of 528 measurements were made on the 4 ETTs. During the complete procedure (connection and disconnection), there was a significant pressure drop of 7 ± 1.4 cm H2O from the initial pressure (Pinitial) (P < .001), of which 6 ± 1.4 cm H2O was lost during connection (difference between Pinitial and Pconnection). The Preconnection value was 19.1 ± 1.6 cm H2O, showing a significant total pressure drop of 11 ± 1.6 cm H2O (difference between Pinitial and Preconnection) (P < .001). The Pfinal mean was 29.6 ± 1.3 cm H2O. Significant differences were found between manometers according to the time of measurement. A similar phenomenon was evidenced when analyzing different ETTs. Significant pressure changes occur secondary to ETT cuff measurement, which has important implications for patient safety.

Pediatric application of cuffed endotracheal tube: a secondary publication translated into Korean

A young child’s larynx was formerly believed to be narrowest at the cricoid level, circular in section, and funnel shaped. This supported the routine use of uncuffed endotracheal tubes in young children despite the benefits of cuffed tubes, such as lower risk for air leakage and aspiration. In the late 1990s, evidence supporting the pediatric use of cuffed tubes emerged largely from anesthesiology studies, while some technical flaws of the tubes remained a concern. Since the 2000s, imaging-based studies have clarified laryngeal anatomy, revealing that it is narrowest at the glottis, elliptical in section, and cylindrical in shape. The update was contemporaneous with technical advances in the design, size, and material of cuffed tubes. The American Heart Association currently recommends the pediatric use of cuffed tubes. In this review, we present the rationale for using cuffed tubes in young children based on our updated knowledge of pediatric anatomy and technical advances.

Pediatric Application of Cuffed Endotracheal Tube.

A young child's larynx was formerly believed to be narrowest at the cricoid level, circular in section, and funnel shaped. This supported the routine use of uncuffed endotracheal tubes (ETTs) in young children despite the benefits of cuffed ETTs, such as lower risk for air leakage and aspiration. In the late 1990s, evidence supporting the pediatric use of cuffed tubes emerged largely from anesthesiology studies, while some technical flaws of the tubes remained a concern. Since the 2000s, imaging-based studies have clarified laryngeal anatomy, revealing that it is narrowest at the glottis, elliptical in section, and cylindrical in shape. The update was contemporaneous with technical advances in the design, size, and material of cuffed tubes. The American Heart Association currently recommends the pediatric use of cuffed tubes. In this review, we present the rationale for using cuffed ETTs in young children based on our updated knowledge of pediatric anatomy and technical advances.

Comparison of Accuracy of Ultrasound Measurement of Subglottic Diameter Versus Conventional Age Based Formula for Estimating Endotracheal Tube Size for Pediatric Surgical Patients- A Prospective Randomized Controlled Study

Introduction: The main aim of this study is to determine if ultrasonography (USG) based measurement of subglottic diameter is the best size predictor for endotracheal tube (ETT) in pediatric surgical cases over age-based formula with micro cuff tube. Also, to test reintubation percentage and post-operative complications in children. Methodology: This research is double-blind randomized control study with 68 children undergoing elective surgery requiring general anaesthesia with micro cuff tube. They were divided into 2 groups i.e. ETT size by USG (group U) and ETT size by age-based formula group A) (with 34 children in each. Both groups ETT measurement was calculated by independent Samples t-test, and correlation of both groups with actual ET Tube was measured by Pearson’s correlation coefficient. Reintubations or post-op complications was measured by Chi-squared test. Results: Mean age of group A and U are 5.65 ± 2.77 and 5.97 ± 2.77 respectively. Mean weights were from 13.5±2.06 kgs to 27±4.63kgs. Statistical significance with a P-value (P=0.0460) is observed in group U whereas no significance was seen in group A. A strong positive correlation (R=0.960) between USG-estimated ETT size and actual ETT size is observed. The difference in reintubations and post-op complications in group U were statistically significant with P &lt; 0.002. Conclusion: The present study concludes that the sub glottis diameter measured by USG is a good predictor for correct size of micro cuff endo tracheal tube in children.

Successful management of endotracheal tube cuff rupture in case of difficult airway scenario for oropharyngeal surgery

Endotracheal tube (ETT) cuff leaks can be encountered in the operating room with variable consequences ranging from a mere annoying bubbling sound to life-threatening respiratory compromise requiring immediate intervention. This scenario becomes more challenging if there is a difficult airway with limited mouth opening and oromaxillofacial surgery where nasal intubation is required with a north pole tube. ETT replacement can expose the patient to airway loss or life-threatening hypoxemia during the ETT exchange. There are no recommended guidelines on how to deal with an ETT cuff leak and no published step-by-step safe management strategy. With the lack of defined protocols and guidelines to manage intraoperative cuff leaks, the presence of mind and ability to make critical decisions by the anesthesiologist cannot be overemphasized. We present a case report of a 40-year-old patient weighing 70 kg diagnosed with carcinoma retromolar trigone posted for wide local excision and posterior segmental mandibulectomy. On airway examination, he had a limited mouth opening of &lt;1 cm, with both nostrils of equal and adequate size. As mask ventilation was not difficult after induction of general anesthesia, we did fiberoptic-guided right nasal intubation with North Pole tube. We were unable to inflate the cuff of ETT and there was a significant leak. Here, we discuss how we exchanged the ETT in this difficult airway scenario.

Efficacy of an Automated Secretion Removal Technology at Different Inspiratory Pressures.

Endotracheal suctioning is resource demanding, causes patient discomfort, and is associated with adverse effects. A new artificial cough method has been developed for automated secretion removal by using rapid deflation and inflation of the endotracheal tube cuff during the inspiratory phase of mechanical ventilation. This method has been evaluated in a bench model and in animals but not in human subjects. The aim of this study was to investigate whether this method can remove the need for endotracheal suctioning in subjects and whether this is dependent on ventilator settings. This prospective, non-controlled study recruited 20 subjects on invasive mechanical ventilation. On the clinical need for endotracheal suctioning, the automatic cough procedure was applied 3 times over 30 s, with this repeated at higher ventilatory pressure and lower respiratory frequency if considered unsuccessful. Success was determined by removal of the clinical need for suctioning. Subject safety and comfort was measured by using the Critical-Care Pain Observation Tool before and after the procedure, and negative effects were recorded. To assess intra-subject variability, the procedure was performed on 3 different occasions for each subject. The procedure was successful in 18 of 20 subjects (90%), with mean subject success rates of 53% at low settings (peak inspiratory pressure 21.8 ± 3.8 cm H2O) and 83% at high settings (peak inspiratory pressure 25.6 ± 3.6 cm H2O). The Critical-Care Pain Observation Tool category remained unchanged in 30 procedures (77%), improved in 7 (18%), and deteriorated in 2 (5%). This study illustrated the potential for significant reduction in the clinical need for endotracheal suctioning after the use of an automated artificial cough procedure at both low and high peak inspiratory pressures, and that was well tolerated.

Post-Intubation Tracheal Stenosis: Multicenter Study from 2010 to 2022

Objective: To study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of post-intubation tracheal stenosis occurring in patients admitted to intensive care units. Patients and methods: This is a multicenter, retrospective and descriptive study conducted from November 1, 2010 to June 1, 2022 in 7 intensive care units and 3 ENT departments. From medical records, we collected epidemiological data (frequency, age, sex), medical history, data relating to tracheal intubation (indication, duration, inflation pressure of the intubation tube balloon), data on post-intubation (PI) tracheal stenosis (symptoms and time to onset), paraclinical data, treatment and evolution modalities. The data collected were expressed as averages with their standard deviation. Results: During the study period, 19 patients presented with PI tracheal stenosis. The frequency ranged from 0.03% to 0.1%. The average age of the patients was 25.7 years 11.07 14-38 years. Patients had been intubated in a traumatic context in 47.37% of cases. The average duration of ventilatory support was 10.37 days  03.03 4-15 days No intubation tube cuff pressure monitoring was done for any patient. Dyspnea was the main telltale sign. Its average time to onset was 33.21  days 12.07 1h-3months. Endoscopically, the average degree of tracheal stenosis was 72.63% 50-99% . Therapeutically, in intensive care, 5 patients (26.31%) who presented with acute respiratory failure underwent a life-saving surgical tracheostomy. Curative surgery resulted in a tracheal resection-anastomosis (73.68%) and enlargement tracheoplasty (26.32%). The outcome was favorable for 9 patients (47.37%). The recurrence of the stenosis after curative surgery was observed in 31.58% of cases. Death occured in 3 patients (15.79%). Conclusion: Over-inflation of the intubation tube cuff is the leading cause of PI tracheal stenosis. Prevention is based on the systematic monitoring of its inflation pressure.

An Efficacy of Intermittent Subglottic Irrigation with 3% NaCl on Prevention of Ventilator-Associated Pneumonia

Background: ventilator-associated pneumonia (VAP) is the leading cause of death associated with healthcare-associated infections, an important cause of morbidity and mortality despite advances in antimicrobial therapy and advanced supportive measures. The accumulation of subglottic secretions above the endotracheal tube (ETT) cuff, as these secretions may leak around the cuff of the ETT resulting in aspiration and an increased risk for infection of VAP. Objective: (1) To assess the efficacy of intermittent subglottic irrigation with 3% NaCl for the prevention of VAP. (2) To assess the association between VAP in the experimental and control group with demographic variables. Materials and Methods: A quantitative research approach and an experimental research design were used for the present study. Simple random sampling technique using a lottery method was used for the selection of the sample. Results: The study revealed that on comparison of VAP for the experimental and control group on days 2nd and 3rd, there is a significant association found. Second day P = 0.003 Significant (S), 3rd day P &lt; 0.0001(S). On 1st day, the experimental group revealed that there is a significant association (P = 0.003) between the duration of the mechanical ventilator and VAP, on the 2nd day, the control group shows the duration of the mechanical ventilator was associated with VAP (P &lt; 0.0001). Conclusion: The conclusion drawn from the present study is intermittent subglottic irrigation with 3% NaCl was effective on the prevention of VAP.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

ALKALINIZED LIGNOCAINE PRELOADED ENDOTRACHEAL TUBE CUFFS REDUCE EMERGENCE COUGH AFTER BRIEF. SURGERY: A PROSPECTIVE RANDOMIZED TRAIL

Aim And Objectives: To evaluate the efcacy of alkalinised lignocaine preloaded endotracheal tube cuffs in reducing emergence cough after brief surgery

Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report

BackgroundTracheoarterial fistula is the most devastating complication after tracheostomy, and its mortality, without definitive treatment, approaches 100%. In general, the combination of bedside emergency management, that is, overinflation of the tracheostomy tube cuff, and definitive treatment such as surgical or endovascular intervention is necessary to prevent the poor outcome. Patients with neuromuscular diseases such as amyotrophic lateral sclerosis are susceptible to tracheoarterial fistula because of long-term mechanical ventilation and muscle weakness.Case presentationWe describe a case of tracheoarterial fistula in a Japanese 39-year-old patient with amyotrophic lateral sclerosis with long-term ventilator management. The patient was clinically diagnosed with a tracheoarterial fistula because of massive bleeding following sentinel hemorrhage. The massive hemorrhage was controlled by overinflation of the tracheostomy tube cuff alone, without definitive treatment.ConclusionsThis case suggests overinflation of the tracheostomy tube cuff alone plays an important role, semi-permanently, in the management of tracheoarterial fistula, especially in cases where surgical or endovascular intervention is not indicated. Clinicians taking care of patients with tracheostomy undergoing long-term mechanical ventilation should be aware that tracheoarterial fistula might occur following tracheostomy.

Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes.

Cricothyrotomy (CTT) has been recommended for use in the pre-hospital setting for military working dogs and Operational K9s during airway emergencies. Although the CTT can establish a patent airway for spontaneous ventilation, the ability to seal the airway and provide positive pressure ventilation (PPV) using tubes designed for humans has not been determined. Using various CTT tubes placed in cadaver dog airways, this study aimed to determine: (1) Whether the tube cuff could create a functional airway seal with safe intra-cuff pressures; (2) The magnitude of delivered tidal volume (TV) loss during a standard breath to assess the possibility of delivering an adequate tidal volume with a bag-valve device (BVM); (3) The best performing tubes for either test; (4) The reasons behind the findings using observations from upper airway endoscopy, dissection, and measurements. Cadaver dogs of similar weights to MWD and Operational K9 breeds had various CTT tubes placed including three from commercial kits, a standard endotracheal tube, and a tracheostomy tube. The minimum occlusive volume technique was used to inflate the tube cuff and a pressure ≤ 48 cm H2O with an adequate seal was considered successful. Individual TVs were calculated for each dog and added to the volume lost during delivery of a standard breath from an ICU ventilator. Endoscopy and airway dissection were performed to assess the relationship between tubes cuffs and the airway. The tubes from the CTT kits performed poorly with regards to producing an airway seal with the H&H tube failing to seal the airway all tests. Tracheal dimensions were significantly associated with successful airway sealing (P = 0.0004). Tidal volume loss could be compensated using a BVM in 34/35 tests with the H&H tube in cadaver 8 the only to fail. Tracheal airway sealing is influenced by airway anatomy when tube cuffs are inflated to a target pressure and larger tubes do not always provide a better seal. The CTT tubes tested have the potential to facilitate ventilation with a BVM under the conditions set in this study. The 8.0 mm endotracheal tube performed the best and the H&H the worst in both tests.

Effect of Fixed Tracheal Cuff Volume vs Fixed Tracheal Cuff Pressure on Hemodynamic Parameters and Postoperative Airway Complications, A Prospective Randomized Control Trial in a Tertiary Care Hospital

Background: The current study is aimed to compare the effect of fixed cuff volume and fixed cuff pressure technique on hemodynamic parameters and on postoperative complications.&#x0D; Methods: The prospective, randomised, controlled study was conducted in a tertiary care hospital with 100 patients aged between 18 to 60 yrs. The patients who are undergoing for elective surgeries under general anaesthesia were enrolled after obtaining ethical committee approval. Patients were randomized based on computer generated random numbers into two groups, fixed volume (7ml) group (group V, n-50) and fixed cuff pressure group (group P, n-50). The ETT cuff was filled with 7 ml of air in the fixed volume technique, and in the fixed cuff pressure group -cuff pressure was maintained at 20 cmH2O, after intubation. Tracheal tube cuff pressures were measured by AMBU cuff pressure gauge manometer. Hemodynamic parameters SBP, DBP, MAP and PR were noted at the time of cuff inflation, after extubation in the both the groups. Post-operative sore throat, hoarseness and cough was assessed at the time of extubation in the both the groups.&#x0D; Results: Mean age in both the groups was 41 years. Statistical significance (P&lt; 0.0001) was observed in Group P in systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, HR whereas no significance was seen in group V. The percentage of post-operative complications like hoarseness, cough, sore throat, and dysphagia were seen to be less in group P when compared to group V.&#x0D; Conclusion: With present data we could conclude that the fixed minimal cuff pressure (20 mm H2O) is an ideal and reliable technique in reducing the post-operative complications along with maintenance of hemodynamic parameters.&#x0D;

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

BackgroundThe incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation.MethodsOne hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed.ResultsCompared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E).ConclusionsCompared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Changes in Endotracheal Tube Cuff Pressure in Open and Laparoscopic Cholecystectomy - A Comparative Study

Changes in Endotracheal Tube Cuff Pressure in Open and Laparoscopic Cholecystectomy - A Comparative Study

Farklı Anestezi Deneyim Düzeyleri Arasında Endotrakeal Tüp Kaf Basıncının Objektif ve Subjektif Değerlendirilmesi

Objective: After endotracheal intubation (ETI), the endotracheal tube cuff (ETTc) should be inflated at sufficient pressure to function, and high pressure should be avoided to prevent complications. In our study, the effect of professional experience on the estimation of ETTcP by palpation is investigated. Method: The study included 75 adult patients with physical status I-III of the American Society of Anesthesiology (ASA) scheduled for ETI. Anesthesia residents were divided into two groups of 20, each with 1 month to 1 year of experience (Group 1) and those with more than 4 years of experience (Group 2). After the ETI, one participant in both groups was asked to inflate the ETTc to an estimated 25 cm H2O by cuff palpation. Then the actual ETTcP was measured with a manometer. Results: The median ETTcP value was 42,00 cm H2O in Group 1 and 32,00 cm H2O in Group 2, (p=0.012). Although the data of both groups were significantly higher than the target value, the values obtained in Group 1 were further away from Group 2 (p&amp;lt;0.001, p&amp;lt;0.001). Conclusion: Professional experience has no effect on the correct estimation of the ETTcP. It is more convenient to measure the actual pressure to avoid undesirable effects of ETTcP outside the target.