Endotracheal Cuff Pressure Research Articles

Regulation of Endotracheal Cuff Pressure

Regulation of Endotracheal Cuff Pressure

Changes in Tracheal Cuff Pressure During Respiratory Support

Tracheal wall movement can affect the lateral wall pressure and seal of an endotracheal cuff. This paper studies the relationship between proximal airway pressure (Paw) and the pressure in high-volume, low- pressure, tracheal tube cuffs. Cuff pressure changes during intermittent mandatory ventilation and continuous positive airway pressure (CPAP) cannot be explained solely by the effect of tracheal pressure, as reflected by Paw, on the annulus of the cuff exposed in the trachea. Cuff pressure showed wide swings and decreased below atmospheric pressure in the presence of small Paw fluctuations during CPAP breathing. Thus, adequate gas flow in the ventilator circuit cannot assure minimal pleural pressure changes. Decreases in cuff pressure may indicate inadequate CPAP and may explain why “just seal” pressure in endotracheal cuffs may not always prevent aspiration.

Changes in tracheal cuff pressure during respiratory support.

Tracheal wall movement can affect the lateral wall pressure and seal of an endotracheal cuff. This paper studies the relationship between proximal airway pressure (Paw) and the pressure in high-volume, low-pressure, tracheal tube cuffs. Cuff pressure changes during intermittent mandatory ventilation and continuous positive airway pressure (CPAP) cannot be explained solely by the effect of tracheal pressure, as reflected by Paw, on the annulus of the cuff exposed in the trachea. Cuff pressure showed wide swings and decreased below atmospheric pressure in the presence of small Paw fluctuations during CPAP breathing. Thus, adequate gas flow in the ventilator circuit cannot assure minimal pleural pressure changes. Decreases in cuff pressure may indicate inadequate CPAP and may explain why "just seal" pressure in endotracheal cuffs may not always prevent aspiration.

Endotracheal Cuff Pressure and Tracheal Mucosal Blood Flow

Large volume, low pressure endotracheal tube cuffs are claimed to have less deleterious effect on tracheal mucosa than high pressure, low volume cuffs. Low pressure cuffs, however, may easily be overinflated to yield pressures that will exceed capillary perfusion pressure. Various large volume cuffed endotracheal tubes were studied, including Portex Profile, Searle Sensiv, Mallinkrodt Hi-Lo, and Lanz. Tracheal mucosal blood flow in 40 patients undergoing surgery was assessed using an endoscopic photographic technique while varying the cuff inflation pressure. It was found that these cuffs when overpressurised impaired mucosal blood flow. This impairment of tracheal mucosal blood flow is an important factor in tracheal morbidity associated with intubation. Hence it is recommended that a cuff inflation pressure of 30 cm H2O (22 mm Hg) should not be exceeded.

Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs

Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs

Cuff Pressure and Microvascular Occlusion in the Tracheal Mucosa:An Intravital Microscopic Study in the Rabbit

A method is described for the intravital microscopic observations of rabbit tracheal mucosa microcirculation during compression with a thin, transparent high volume cuff. The cuff pressure (CP) required to cause complete ischemia in the mucosa over the cartilages was measured and a correlation was found to the mean arterial blood pressure (MAP). Ischemia was not observed below CP-MAP ratios of 0.40 for untreated animals or below 0.44 for animals where the MAP had been elevated by adrenalin. However, marked reduction of the microvascular blood flow was present at lower CP-MAP ratios, 0.2-0.3, which at a MAP of 75 mmHg corresponds to cuff pressures of 15-20 mmHg. It is therefore advocated that endotracheal cuff pressures are kept below these values to avoid ischemic tissue injury.