Endotracheal Tube Cuff Pressure Research Articles

A Hydraulic Auto-inflator for Endotracheal Tube Cuff Pressure Management.

A Hydraulic Auto-inflator for Endotracheal Tube Cuff Pressure Management.

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

Postoperative sore throat (POST) is a common complication following endotracheal tube removal, and effective preventive strategies remain elusive. This trial aimed to determine whether actively regulating intraoperative cuff pressure below the tracheal capillary perfusion pressure threshold could effectively reduce POST incidence in patients undergoing gynecological laparoscopic procedures. This single-center, randomized controlled superiority trial allocated 60 patients scheduled for elective gynecological laparoscopic procedures into two groups: one designated for cuff pressure measurement and adjustment (CPMA) group, and a control group where only cuff pressure measurement was conducted without any subsequent adjustments. The primary outcome was POST incidence at rest within 24h post-extubation. Secondary outcomes included cough, hoarseness, postoperative nausea and vomiting (PONV) incidence, and post-extubation pain severity. The incidence of sore throat at rest within 24h after extubation in the CPMA group was lower than in the control group, meeting the criteria for statistically significant superiority based on a one-sided test (3.3% vs. 26.7%, P < 0.025). No statistically significant differences were observed in cough, hoarseness, or pain scores within 24h post-extubation between the two groups. However, the CPMA group had a higher incidence of PONV compared to the control group. Additionally, the control group reported higher sore throat severity scores within 24h post-extubation. Continuous monitoring and maintenance of tracheal tube cuff pressure at 18 mmHg were superior to merely monitoring without adjustment, effectively reducing the incidence of POST during quiet within 24h after tracheal tube removal in gynecological laparoscopic surgery patients. The study was registered at www.chictr.org.cn (ChiCTR2200064792) on 18/10/2022.

Leveraging artificial intelligence to identify high-risk patients for postoperative sore throat: An observational study.

Postoperative sore throat (POST) is a prevalent complication after general anesthesia and targeting high-risk patients helps in its prevention. This study developed and validated a machine learning model to predict POST. A total number of 834 patients who underwent general anesthesia with endotracheal intubation were included in this study. Data from a cohort of 685 patients was used for model development and validation, while a cohort of 149 patients served for external validation. The prediction performance of random forest (RF), neural network (NN), and extreme gradient boosting (XGBoost) models was compared using comprehensive performance metrics. The Local Interpretable Model-Agnostic Explanations (LIME) methods elucidated the best-performing model. POST incidences across training, validation, and testing cohorts were 41.7%, 38.4%, and 36.2%, respectively. Five predictors were age, sex, endotracheal tube cuff pressure, endotracheal tube insertion depth, and the time interval between extubation and the first drinking of water after extubation. After incorporating these variables, the NN model demonstrated superior generalization capabilities in predicting POST when compared to the XGBoost and RF models in external validation, achieving an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI 0.74-0.89) and a precision-recall curve (AUPRC) of 0.77 (95% CI 0.66-0.86). The model also showed good calibration and clinical usage values. The NN model outperforms the XGBoost and RF models in predicting POST, with potential applications in the healthcare industry for reducing the incidence of this common postoperative complication.

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

Comparison of Endotracheal Tube Cuff Pressure change between Supine prone and Supine – Knee Chest Position in Lumbar Disc Surgery

Background: In rare instances, massive over inflation of the cuff may lead to acute complications such as tracheal bleeding or rupture. This may be associated with post-operative complications like sore throat hoarseness of voice. The purpose of this study was to evaluate the ETT cuff pressure changes between supine to prone and supine to knee chest position in lumber disc surgery. Materials &amp; Methods: Sixty patients, aged between 18 to 60 years of either sex, belonging to American Society of Anaesthesiology (ASA) physical status I to II undergoing elective lumbar disc surgery under general anaesthesia either in prone position or in knee-chest position were considered for this study. The patients were randomly allocated into two groups of 30 patients each. Group “p” was undergone operation in prone position and group “k” undergone operation in knee-chest position. The patients were connected to standard monitoring system such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), pulse oxymeter, and capnometer. All patients were pre-medicated with inj. glycopyrrolate 0.2 mg and inj. fentanyl 2µg/kg iv 5-6 minutes before induction of anaesthesia and were pre-oxygenated with 100% oxygen for atleast 3 minutes. All the patients were induced with inj. propofol 2.5 mg/kg i.v. followed by inj. rocuronium at a dose of 1.2 mg/kg for facilitating tracheal intubation with reinforced ETT. The ETT size selected for men and women were 8.0-8.5 mm ID and 7.0- 7.5 mm ID (Mallinckrodt) respectively. Results: Group k patients showed higher cuff pressure change from 25 to 39.97cm of H2O compared to group p from 25 to 30.47 cm of H2O after change of position only. There was statistically significant different found between groups Sore throat was found significantly higher in group k compared to group p (20% vs 16.67%). Conclusion: The cuff pressure of the endotracheal tube should be monitored and managed properly after the position change from supine to prone and prone to knee chest position.

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.

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.

Effect of Shallow versus Deep Suctioning Techniques on Endotracheal Tube Cuff Pressure Measurements and Physiological Indices among Patients Undergoing Mechanical Ventilation

Effect of Shallow versus Deep Suctioning Techniques on Endotracheal Tube Cuff Pressure Measurements and Physiological Indices among Patients Undergoing Mechanical Ventilation

Endotracheal Tube Cuff Pressures and Incidence of Postoperative Sore Throat

Abstract not available J Bangladesh Coll Phys Surg 2024; 42: 4-5

Bilateral vocal cord paralysis and airway obstruction during postoperative period after partial glossectomy

Bilateral vocal cord paralysis is a rare complication of endotracheal intubation, causing serious problems. We report a case of bilateral vocal cord paralysis and airway obstruction in the postoperative period after partial glossectomy. A 61-year-old male patient with diabetes mellitus underwent partial glossectomy under general anesthesia. The anesthesia during surgery was uneventful. After extubation, the patient appeared to have airway obstruction and complained of dyspnea. Flexible fiberoptic laryngoscopy was performed immediately, and the patient was diagnosed with bilateral vocal cord paralysis. Therefore, reintubation was performed. The patient was extubated the following day and discharged with incomplete recovery of vocal cord paralysis. The study findings indicate that inappropriate endotracheal tube location and cuff pressure can cause bilateral vocal cord paralysis. The involvement of head position and tongue traction during glossectomy was suggested in this case. Anesthesiologists should be able to consider and manage bilateral vocal cord paralysis in patients with airway obstruction in the postoperative period.

IoT-Enabled Design and Implementation of an Endotracheal Tube Cuff Pressure Controller Device

IoT-Enabled Design and Implementation of an Endotracheal Tube Cuff Pressure Controller Device

Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study.

Endotracheal tube cuff pressure (ETCP) is an important factor to determine the development of complications associated with invasive mechanical ventilation. To avoid preventable complications arising out of immobilization, frequent changes in body positioning are necessary. Such variations in body position can affect ETCP in critically ill patients who are on mechanical ventilation. So, our study aimed to assess the effect of changes in body position on ETCP in patients who are on mechanical ventilation. This prospective observational study included 31 critically ill intubated patients. Each study subject was first placed in a neutral starting position with a 30º head elevation. Then, they were subjected to a sequential change in body position based on the 16 most used positions as part of the critical care unit's (CCUs) daily routine. Endotracheal tube cuff pressure was measured after each position change. Data were analyzed using standard statistical tests. Statistically significant difference in ETCP was observed during anteflexion of neck, hyperextension of neck, left lateral flexion of neck, right lateral flexion of neck, left lateral rotation of neck, right lateral rotation of neck, 10o recumbent position, supine position, Trendelenburg position, and right lateral 30° and 45° positions. Maximum increase in ETCP was seen during anteflexion of neck (31 ± 4.5; 22-42 cm H2O). Our study demonstrates significant deviations in ETCP from the recommended range following changes in the body position of mechanically ventilated patients, highlighting the need for the measurement of ETCP after each position change and maintenance of the same within the target range. Roy O, Dasgupta S, Chandra A, Biswas P, Choudhury A, Ghosh S, et al. Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study. Indian J Crit Care Med 2024;28(1):36-40.

Retracted: The Relationship between Cuff Pressure and Air Injection Volume of Endotracheal Tube: A Study with Sheep Trachea Ex Vivo

Retracted: The Relationship between Cuff Pressure and Air Injection Volume of Endotracheal Tube: A Study with Sheep Trachea Ex Vivo

A Prospective Randomized Controlled Trial of the Effect of Maintenance of Continuous Cuff Pressures (20 cmH2O vs 30 cmH2O) on Postoperative Airway Symptoms in Laparoscopic Surgeries.

Recently, laparoscopic surgery has been used in many fields of surgery. It has been reported that cuff pressure becomes high during laparoscopic surgery. Increased cuff pressure may cause postoperative sore throat and hoarseness. Considering previous reports, we hypothesized that maintenance of a fixed low cuff pressure during laparoscopic surgery might be associated with low grades of postoperative sore throat and hoarseness. The participants were 100 patients between 20 and 80 years of age who were scheduled to undergo laparoscopic surgery lasting over 2 hours. Patients were randomly allocated to two groups with endotracheal tube cuff pressures fixed at 20 cmH2O (low-pressure group; LPG) and 30 cmH2O (high-pressure group; HPG). We evaluated mainly sore throat and hoarseness on postoperative day 1 using a visual analog scale (VAS; 0-10 cm). Statistical comparisons of values were performed using the unpaired t-test, Mann-Whitney U-test, and chi-square test with values of p < 0.05 considered statistically significant. There were no significant differences in background characteristics between the two groups. Median postoperative scores for the LPG and HPG were 1 (interquartile range, 0-3) and 0 (0-2; p = 0.560) for sore throat and 2 (0-4) and 1 (0-3; p = 0.311) for hoarseness, respectively, and the differences were not significant. The effects of maintenance of a fixed low cuff pressure and a fixed high cuff pressure on the degrees of postoperative sore throat and hoarseness after laparoscopic surgery were the same and the grades were low.

Comparison of the effect of pressure control and volume control ventilation on endotracheal tube cuff pressure in patients undergoing general anesthesia and mechanical ventilation: a parallel randomized clinical trial

BackgroundEndotracheal intubation and mechanical ventilation are prevalent interventions in the operating room and intensive care unit. Recently, the complications of endotracheal tube cuff pressure have been a topic of interest. Therefore, this study compared the effect of pressure control and volume control ventilation modes on the endotracheal cuff pressure rate in patients undergoing general anesthesia and mechanical ventilation.MethodsIn this triple-blinded randomized clinical trial, 50 patients undergoing open limb surgery and inguinal hernia were allocated to two groups of 25 based on inclusion criteria. After intubation, one group underwent ventilation on the pressure control ventilation mode, and the other underwent ventilation on the volume control ventilation mode. In both groups, using a manometer, the cuff’s pressure was first adjusted in the range of 25–30 cm of water. Then, the cuff pressure was measured at 10, 20, and 30 min intervals. The data were statistically analyzed using independent t-test, and two-way repeated measures ANOVA.ResultsThe present study’s findings showed that cuff pressure has significantly decreased over time in both study groups (F = 117.7, P < 0.001). However, a repeated measures ANOVA with a Greenhouse-Geisser correction showed no interaction between time and groups (F = 0.019, P = 0.98). The two groups had no significant difference in cuff pressure (F = 0.56, P = 0.458).ConclusionSince the cuff pressure has been significantly reduced in both groups over time, continuous monitoring of endotracheal tube cuff pressure in patients undergoing mechanical ventilation is essential. Therefore, it is suggested to keep the cuff pressure within the recommended range to prevent complications resulting from cuff pressure reduction, such as aspiration and ventilation decrease.Trial registrationThe study was registered in the Iranian Registry of Clinical Trial on 23/02/2019 (trial registration number: IRCT20181018041376N1).

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.

Evaluation of the Effect of the Endotracheal Tube Cuff Pressure Measurement on Postoperative Sore Throat

BACKGROUND&#x0D; Following general anaesthesia, up to 62% of patients experience postoperative sore throat. Despite the fact that it resolves on its own, efforts must be made to reduce it. We wanted to evaluate the difference between conventional method and instrumental measurement of cuff pressure in incidence and severity of postoperative sore throat in this study.&#x0D; METHODS&#x0D; A prospective observational study that included 150 adult patients aged &lt; 50 years scheduled for elective surgical operation requiring general anaesthesia and endotracheal intubation. They were divided randomly into two groups: Group A included 75 patients and the adequacy of cuff inflation was generally assessed clinically and group B included 75 patients and the adequacy of cuff inflation was generally assessed by using a cuff manometer.&#x0D; RESULTS&#x0D; Incidence of postoperative sore throat in all times was significantly lower in Group B than in Group A. Prevalence of mild postoperative sore throat after one hr. was significantly higher in group B than that in group A (94.1% versus 61.4%, P= 0.001).&#x0D; CONCLUSIONS&#x0D; Impaired tracheal mucosal blood flow was an important factor in the incidence of postoperative sore throat associated with tracheal intubation and recommended that a cuff inflation pressure of 30 cmH2O should not be exceeded.

The effect of prolonged intubation on ventilator associated pneumonia: endotracheal tube cuff is really steril or not?

Aims: Endotracheal tube (ETT) design, size, cuff material, cuff pressure, and intubation duration are critical in preventing nosocomial pneumonia. We aimed to evaluate the possible infection focus potential of ETT cuff and pilot balloon, particularly in prolonged intubated patients. Methods: A total number of 66 patients who underwent orotracheal intubation and received conventional mechanical ventilation more than 48 hours in the intensive care unit (ICU), were included in this prospective cohort study. Results:The mean duration of intubation was 10.36±4.82 days. Bacteriologically confirmed positive tracheal aspirate culture was 18.2% (n=12). The most frequent positive culture was detected inside of ETT lumen with a percentage of 83.3% (n=55) and followed by cuff (27.3%, n=18), pilot balloon (13.6%, n=9), respectively. It was documented that rates of lung infections were significantly increased after 14 days (p = 0.017) and rates of cuff positive cultures were significantly increased after 10 and 14 days of incubation (p= 0.001, p=0.004). The same type of bacteriological strains was identified from both pilot balloon (n=9) and ETT cuff (n=9), simultaneously. In the remaining 9-cuff positive patients pilot balloons were sterile and ETT lumens were positive culture with the same strains as identified from the cuff. There was a statistically significant positive correlation between the intubation duration and the number of infected ETT parts (p&lt;0.001). Conclusion: ETT cuff was demonstrated to be a potential infection focus in the present study. In addition, it was observed that ETT cuff colonization increased in proportion to the intubation duration. We suggest changing ETT at appropriate time intervals in order to reduce ventilator-associated pneumonia in intubated patients.

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.