Endotracheal Tube Cuff Pressure Monitoring Research Articles

Investigating Different Endotracheal Tube Cuff Pressure Monitoring Methods and their Role in Postoperative Sore Throat among Tracheal Intubation Patients: A Randomized Study

Investigating Different Endotracheal Tube Cuff Pressure Monitoring Methods and their Role in Postoperative Sore Throat among Tracheal Intubation Patients: A Randomized Study

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial

BackgroundPostoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults.MethodsOne hundred and fourteen ASA I-III patients of either gender, aged 18–65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough.ResultsOne hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0–0), which was significantly lower than those in group C (1 (0–2) at 2 h, p < 0.001 ; 1 (0–1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0–1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0–2) was superior to that in group C (2 (0–2), p = 0.006) at 2 h postoperatively.ConclusionsIn conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

The Effect of Topical Benzydamine Hydrochloride and Cuff Pressure Monitorization on Postoperative Sore Throat Due to Intubation.

Postoperative sore throat (POST) is the most common discomfort after endotracheal intubation. Damage to the tracheal mucosa caused by inappropriate endotracheal tube (ETT) cuff pressure has been shown as the major factor. Monitoring the ETT cuff pressure at a certain value reduces this damage. Benzydamine hydrochloride (BH) has proven to be effective on sore throat and studies have shown that it is also effective on POST. In this study, the efficacy of BH and ETT cuff pressure monitoring on POST was evaluated. After ethics committee approval 210 patients in the ASA (American Society of Anesthesiologists) I-III risk group undergoing elective surgery were included in the study. Routine anesthesia monitoring, induction, and maintenance were provided. Patients were randomly divided into three groups. Thirty minutes before surgery, the posterior pharyngeal wall was sprayed with BHin group 1and distilled water in groups 2 and 3. Intraoperatively, the first and second groups were monitored to keep the ETT cuff pressure between 22 and 26 cmH2O, while no intervention was performed in the third group. The incidence and severity of postoperative dysphagia, hoarseness, and POST were questioned. There was no difference between demographic data, and gender was not associated with POST. There was a statistically significant difference between the first and second groups and the third group in terms of all three symptoms questioned (p<0.01). No difference was observed between the first and second groups. Side effect rates were similar. Smoking was not found to be associated with symptoms. The incidence and severity of POST, dysphagia, and hoarseness are reduced when the ETT cuff is inflated with a pressure of 22-26 cmH2O after intubation with a manometer and maintained at this pressure range throughout the operation. There was no beneficial effect of BH.

Changes in endotracheal tube cuff pressure with the changes in peak airway pressures during total laparoscopic hysterectomy and pelvic surgeries. A prospective and observational study

Background: The abdominal insufflation and changes in endotracheal tube (ETT) cuff pressure due to creation of pneumoperitoneum and changes in patient positioning during laparoscopic abdominal surgeries have not been explored thoroughly. Aims and Objectives: The aim of our study was to see the changes in ETT cuff pressures during creation, maintenance, release of pneumoperitoneum, and during surgical positioning. Materials and Methods: A total of 60 patients were finally taken for study. Written informed consent was taken for participation in the study as well as consent for surgery. Inclusion criteria were patients of age above 30 years, American society of anesthesiology physical status 1 and 2, patients undergoing total laparoscopic hysterectomy requiring trendelenburg positioning. Exclusion criteria were patients with pre-existing pulmonary or cardiac disease, patients with pre-existing vocal cord palsy, goitre or any other airway or thoracic pathology, pregnant or lactating females, BMI more than 25 or &lt;18.5. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analyzed and compared. Results: Baseline cuff pressure after manual inflation was 28.85±11.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (P&lt;0.05). Serial measurements of ETT cuff pressure, peak airway pressure, and ETCO2 were significantly increased compared to baseline (P&lt;0.05). Conclusion: Pneumoperitoneum in Trendelenburg position increases ETT cuff pressure probably due to increase in airway pressure. Therefore, it seems advisable to include routine monitoring of ETT cuff pressure. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries.

A Rare Complication: Tracheal Laceration after Routine Intubation at the Tamale Teaching Hospital

Patients Tracheal perforation is a rare complication of endotracheal intubation that usually presents as a linear lesion in the membranous wall of the trachea. It is more prevalent in women (because they have shorter stature and a weaker pars membranosa compared to men), patients 50 years and older and patients less than 160 cm tall. Most common clinical manifestations includesubcutaneous emphysema, pneumomediastinum, pneumothorax, respiratory distress and haemoptysis. We report the case of a young male presenting with tracheal perforation after routine endotracheal intubation. This case was managed conservativelywithout complications. Possible causes for the injury include: over-inflation of the endotracheal tube cuff, intubation by an inexperienced anaesthetist or use of an inappropriately sized tube for the patient. Clinical suspicion must be followed by diagnostic confirmation, which was achieved by direct visualization of trachea rupture on bronchoscopy. We therefore encourage endotracheal tube cuff pressure monitoring during general anaesthesia and direct supervision of an inexperienced anaesthetists during critical events such as induction and intubation.

Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients.

Background:Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients.Methods:A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group.Results:A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036).Conclusions:The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.

Application of Endotracheal Tube Cuff Pressure Monitoring during Percutaneous Dilatational Tracheostomy: A Novel Technique.

Endotracheal tube (ETT) cuff pressure monitoring during percutaneous dilatational tracheostomy (PDT) procedure is an easy-to-use innovative addition to the standard blind technique in a resource-limited setting. This technique can be carried out without disconnecting the breathing circuit, resulting in a lower risk of infectious aerosol generation.How to cite this articleMohammad H, Jain G, Agarwal A, Kausar S, Sama S. Application of Endotracheal Tube Cuff Pressure Monitoring during Percutaneous Dilatational Tracheostomy: A Novel Technique. Indian J Crit Care Med 2021;25(9):1040–1041.

Evaluation of Endotracheal Tube Cuff Pressure in Intubated Patients in Emergency Department, Operating Rooms, and Icus of Imam Khomeini Hospital Complex in 2018; A Cross Sectional Study

Background: Establishing and maintaining a secure airway using a cuffed endotracheal tube (ETT) is an important step in management of intubated patients. Out-of-range ETT cuff pressure is associated with various complications which could lengthen the hospital stay. The aim of this cross-sectional study was to evaluate ETT cuff pressure in intubated patients in the emergency department (ED), operating rooms (ORs), and Intensive Care Units (ICUs) of Imam Khomeini Hospital Complex (IKHC), Tehran, Iran.&#x0D; Methods: The ETT cuff pressure of 153 patients was measured using a standard manometer. Demographic data and duration of intubation were recorded. The data were analysed using the SPSS software version 16. P values less than 0.05 were considered significant.&#x0D; Results: The ETT cuff pressure exceeded the recommended range in 125 out of 153 patients (81.7%). The mean cuff pressure (67.29 cmH2O) was significantly higher than the recommended range (p&lt;0.001). The cuff pressure was higher in patients in the ORs compared to patients in the ED and ICU (OR=8.46, p&lt;0.001).&#x0D; Conclusion: Intubation in the OR can be considered a risk factor for higher-than-normal ETT cuff pressure and subsequent complications. The ETT cuff pressure monitoring by means of a manometer is recommended.

Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES).

ObjectiveTo study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment.Materials and methodsThis was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg.ResultsOut of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables.ConclusionOur findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098).Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737How to cite this articleShaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181–184.

Journal of Clinical Monitoring and Computing 2018-2019 end of year summary: respiration.

This paper reviews 28 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2018 and 2019, within the field of respiration. Papers were published covering endotracheal tube cuff pressure monitoring, ventilation and respiratory rate monitoring, lung mechanics monitoring, gas exchange monitoring, CO2 monitoring, lung imaging, and technologies and strategies for ventilation management.

A Literature Review on Strategies Preventing Ventilator-Associated Pneumonia: Role of Endotracheal Cuff Pressure, Cuff Material, and Cuff Shape

ObjectivesTo provide an overview of existing literature regarding the effects of ETT cuff pressure, cuff material, and cuff shape on VAP prevention in adult ventilated patients.BackgroundVentilated patients are at risk of ventilator-associated pneumonia (VAP), which can result in many adverse consequences, such as increased length of stay, mortality, and hospital cost. Endotracheal tube (ETT) insertion is a commonly used measure for mechanical ventilation. However, ETT cuff pressure, special cuff material, and special cuff shape may affect the occurrence of VAP in ventilated patients, but the evidence for their effects on VAP prevention has not been synthesized.MethodsA literature review was conducted.FindingsTwenty-two studies involving 8,809 patients were included in this literature review. The reviewed studies showed inconsistent findings of the effects of continuous ETT cuff pressure monitoring (compared with intermittent pressure monitoring), polyurethane ultrathin tracheal tube (compared with polyvinyl chloride tracheal tube), and taper-shaped cuff (compared with conical-shaped cuff) on the prevention of VAP. Two studies reported consistent findings that silver-coated ETT significantly reduced bacterial load and incidence of VAP compared with uncoated ETT, but the evidence level was relatively weak.ConclusionThis literature review provides an initial and brief overview of the effects of ETT cuff pressure, cuff material, and cuff shape on preventing VAP. However, the effectiveness of these interventions remains inconclusive due to the inadequate evidence and low quality of previous studies. The intervention effects should be synthesized using a quantitative method and laboratory studies with rigorous design are needed to provide more solid evidence.

A simple and widely available alternative method for endotracheal tube cuff pressure monitoring

A simple and widely available alternative method for endotracheal tube cuff pressure monitoring

Use of digitalised continuous endotracheal tube cuff pressure monitoring in anterior cervical spine surgery

Use of digitalised continuous endotracheal tube cuff pressure monitoring in anterior cervical spine surgery

Continuous monitoring of endotracheal tube cuff pressure: best practice in intensive care unit

The endotracheal tube cuff pressure must be maintained within an optimal range of 20-30 cmH2O, which ensures ventilation, prevents aspiration of secretions and guarantees a good tracheal perfusion. To describe changes in the endotracheal tube cuff pressure over time through a continuous monitoring device, and assess the number of nursing actions. Observation of 72 patients admitted to a general ICU and monitored for 12 hours, with a continuos monitoring device of endotracheal tube cuff pressure (PressureEasy(®)). During the first four hours 4 cases (5.6%) of underinflated cuff were observed, and 5 (6.9%) of overinflation. From the fifth to the eighth hour 7 (9.7%) patients showed a pressure <20 cmH2O, and 3 (4.2%) >30 cmH2O. During the last four hours 22 cases (30.5%) of underinflated cuff, and 4 (5.6%) of overinflation were observed. More than half of the patients (n=38, 52.8%) did not require any intervention of inflation or deflation of the cuff, 25 (34.7%) only one and 7 (9.7%) patients two, and twe patients, three. The majority of patients required the inflation of the cuff. Our study supports the need of continuous endotracheal tube cuff pressure monitoring to promptly identify deviations from the pressure ranges, allowing their rapid correction.

Comparison of minimal leak test and manual cuff pressure measurement technique method for inflating the endotracheal tube cuff

Background: Appropriate management of endotracheal tube (ETT) cuff pressure is essential during mechanical ventilation of an intubated patient. The ETT cuff should be inflated in order to seal the airway without volume loss or pharyngeal content aspiration. It is desirable that the cuff seal the airway without exerting high pressure on the trachea to compromise mucosal circulation. The aim of this study is to assess importance of monitoring of ETT cuff pressure in intubated patients and effect of intervention in preventing complications related to over and under inflation of ETT cuff . Method: An observational prospective study performed between January and April 2015. All patients having cardiac surgery with cuffed ETT insertion were included. In Group1 cuff pressure manometer was used to monitor the cuff pressure and adjusted in the range of 20-30 cm H2O within 15 min before going on cardiopulmonary bypass. In Group2 only minimal leak test (MLT) done to guide inflation and cuff pressure measured by cuff pressure manometer but no intervention was made. Patients were followed in postsurgical care till extubation and observed till discharge for complication like sore throat, voice changes and tracheomalacia. Results: In group 1 9(25.7%) patient had cuff pressure within normal limit whereas 25 (71.4%) patient had cuff pressure higher than normal and 1 (2.9%) patient had cuff pressure measurement less than 20 cm H2O. Volume of air added or removed from cuff was -0.89 ± 1.14 to optimize cuff pressure. Cuff pressure ranged from 15 to 120(47 ± 23) cm H2O.In group 2 11(32.4%) patient had cuff pressure within normal limit whereas 22 (64.7%) patients had cuff pressure higher than normal and 1 (2.9%) patient had cuff pressure measurement less than 20 cm H2O. Cuff pressure ranged from 18 to 100(47.4±20.3) cm H2O. In group 1, 11 patients developed hoarse voice compared to 32 patients in group 2. P=0.000 In group 1, 15 patient developed sore throat versus 21 patients in gro

Endotracheal Tube Cuff Pressure Monitoring in Children

Objective: to estimate tracheal morphological changes in children, by using a device for the continuous monitoring and regulation of endotracheal tube cuff pressure. Subjects and methods. Two groups of children were examined. In Group A comprising 22 children aged 2 months to 16 years, the adequacy of the external control balloon palpation method was estimated to measure endotracheal tube cuff pressure. In Group B consisting of 12 children aged 5 to 18 years on mechanical ventilation for more than 3 days, the efficiency and appropriateness of applying a PressureEasy device for monitoring the pressure in the endotracheal tube cuff were assessed to prevent postintubation tracheal complications. In the latter group, the authors identified a study subgroup (BI) of 8 patients where this device was employed and a control group of 4 patients (BII) where it was not used. Results. Group A showed that endotracheal tube cuff pressure was 20—30 cm H2O in 31.8% of cases, greater than 30 cm H2O in 36.4%, and lower than 20 cm H2O in 31.8%. Subgroup BI displayed considerably lower macro- and microscopic histological changes than Subgroup BII. Conclusion. Determination of endotracheal tube cuff pressure by palpation of the external control balloon does not reflect its real values. The magnitude of tracheal changes is more intensive if continuous monitoring and regulation of pressure in the endotracheal tube cuff is absent. The PressureEasy device to monitor endotracheal tube cuff pressure permits its variability maintenance at a given level, by mitigating the damaging effect of the cuff on tracheal tissue. Key words: endotracheal tube, cuff, histology, ischemia, prevention, pressure, trachea.

Endotracheal Tube Cuff Pressure Monitoring: A Review of the Evidence

Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13-20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively.

Endotracheal tube cuff pressure monitoring during neurosurgery - Manual vs. automatic method.

Background:Inflation and assessment of the endotracheal tube cuff pressure is often not appreciated as a critical aspect of endotracheal intubation. Appropriate endotracheal tube cuff pressure, endotracheal intubation seals the airway to prevent aspiration and provides for positive-pressure ventilation without air leak.Materials and Methods:Correlations between manual methods of assessing the pressure by an experienced anesthesiologists and assessment with maintenance of the pressure within the normal range by the automated pressure controller device were studied in 100 patients divided into two groups. In Group M, endotracheal tube cuff was inflated manually by a trained anesthesiologist and checked for its pressure hourly by cuff pressure monitor till the end of surgery. In Group C, endotracheal tube cuff was inflated by automated cuff pressure controller and pressure was maintained at 25-cm H2O throughout the surgeries. Repeated measure ANOVA was applied.Results:Repeated measure ANOVA results showed that average of endotracheal tube cuff pressure of 50 patients taken at seven different points is significantly different (F-value: 171.102, P-value: 0.000). Bonferroni correction test shows that average of endotracheal tube cuff pressure in all six groups are significantly different from constant group (P = 0.000). No case of laryngomalacia, tracheomalacia, tracheal stenosis, tracheoesophageal fistula or aspiration pneumonitis was observed.Conclusions:Endotracheal tube cuff pressure was significantly high when endotracheal tube cuff was inflated manually. The known complications of high endotracheal tube cuff pressure can be avoided if the cuff pressure controller device is used and manual methods cannot be relied upon for keeping the pressure within the recommended levels.

Endotracheal tube cuff pressure monitoring in peripheral hospitals

Background: An improvised monitor was designed in a peripheral hospital to measure the tracheal tube cuff pressures in patients intubated under anaesthesia. The aim of the study was to assess the efficacy of assessment of cuff pressure by the traditional palpatory method and to compare the improvised monitor with the standard monitor commercially available. The effect of nitrous oxide on the cuff-pressure was also studied. Methods: The tracheal tube cuff pressure of 80 patients undergoing general anaesthesia was assessed by palpation and measured with an improvised and standard monitor. Results: The study showed that the tracheal cuff pressure recorded were higher than normal tracheal perfusion pressure in 40% of the cases with satisfactory palpatory assessment. The pressures recorded by the improvised monitor were comparable to that of the standard monitor. The use of nitrous oxide resulted in increase in cuff pressures over a period of time. Conclusion: An objective measurement by any equipment is superior to assessment of cuff pressure by palpation. The improvised monitor can be used to give a fair idea of the cuff pressures, in places where a standard monitor is not available.

On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery.

A retrospective review of contemporaneously acquired clinical data supplemented by experimental cadaver dissection. To establish the incidence and mechanism of vocal cord paralysis after anterior cervical spine surgery and to determine whether controlling for endotracheal tube (ET)-laryngeal wall interactions induced by the cervical retraction system could decrease the rate of paralysis. Vocal cord paralysis is the most common otolaryngologic complication after anterior cervical spine surgery. However, the quoted frequency of this varies considerably, and the cause of the injury is not clearly defined. As a result, various, and at times contradictory, recommendations to prevent this are presented without data to support their effectiveness. Data gathered at the time of surgery and during follow-up visits on 900 consecutive patients who underwent anterior cervical spine surgery with plating during a 12-year interval were entered into a computerized database and reviewed for complications and procedural risk factors. After the first 250 cases an intervention consisting of monitoring ET cuff pressure and release of pressure after retractor replacement or repositioning was used, which allowed the ET to recenter within the larynx. The ET-laryngeal wall relation also was studied in fresh intubated cadavers using videofluoroscopic images, before and after retractor placement. Thirty incidences of vocal cord paralysis consistent with recurrent laryngeal nerve (RLN) injury were identified: 27 temporary and 3 permanent. The rate of temporary paralysis decreased from 6.4% to 1.69% (P = 0.0002) after institution of the described maneuver. The findings confirmed that the retractor displaced the larynx against the shaft of the ET, allowing impingement on the vulnerable intralaryngeal segment of the RLN. The most common cause of vocal cord paralysis after anterior cervical spine surgery is compression of the RLN within the endolarynx. Monitoring of ET cuff pressure and release after retractor placement may prevent injury to the RLN during anterior cervical spine surgery.