Tracheal Tube Cuff Pressure Research Articles

Changes of endotracheal tube cuff pressure and its indicators in laparoscopic resection of colorectal neoplasms: an observational prospective clinical trial

BackgroundLaparoscopic surgery is a popular alternative for resection of colorectal neoplasms. Carbon dioxide pneumoperitoneum and Trendelenburg positioning in procedure can significantly increase airway pressure, when endotracheal tube cuff pressure is not monitored. This prospective observational study aimed to evaluate indicators, changes and its correlation factors of endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms.Methods122 patients scheduled for laparoscopic resection of colorectal neoplasms under propofol/remifentanil total intravenous anesthesia with orotracheal intubation were included. Tracheal tube cuff pressure was monitored continuously by calibrated pressure transducers. The ability of several predictors to predict out-of-range tracheal tube cuff pressure at different time points and its correlation factors were assessed.ResultsROC analysis showed that waist-to-hip ratio has the highest AUC for predicting out-of-range tracheal cuff pressure (AUC: 0.86 [95% CI: 0.77–0.95]); Tracheal tube cuff pressure provided by palpation was 41.0 (29.0−53.3) cmH20. Cuff pressure was 33.7 ± 2.9 cmH20 at 15 min and comparable at 30 and 45 min after insufflation, all values were significantly higher than 25 cmH20 (p < 0.001). Multiple linear regression showed tracheal tube cuff pressure was associated with peak airway pressure (p < 0.001).ConclusionsPatients with normal BMI undergoing laparoscopic resection of colorectal neoplasms require continuous monitoring and timely adjustments of tracheal tube cuff pressure. Compared with BMI, waist-to-hip ratio is a better predictor of out-of-range tracheal tube cuff pressure.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Educational Intervention Can Improve the Pilot Balloon Palpation Method of Tracheal Tube Cuff Pressure Monitoring: An Experimental Study

Abstract Background: Considerable morbidity is attributable to inappropriate tracheal cuff pressure. An earlier study undertaken in our hospital revealed that a normal cuff pressure of 20–30 cm H2O was achieved in only 6% of intubated patients using subjective estimation methods. Objective: To determine whether a training intervention could improve the accuracy of the subjective estimation method in our tracheal cuff monitoring. Materials and Methods: A 1-day training session was conducted in April 2022 for our anaesthesia providers. The cuffs of different sizes of endotracheal tubes were inflated to 25 cm H2O, and each staff was requested to feel the turgor of the pilot balloon. Subsequently, anaesthesia providers used pilot balloon palpation for the regulation of the tracheal cuff pressure in consecutive patients undergoing general anaesthesia with endotracheal intubation. During each intubation, a manometer was used to crosscheck the inflated cuff pressure objectively. The incidence of post-operative sore throat was also evaluated. The obtained outcomes were compared with pre-intervention data obtained from an earlier study conducted in the health facility from October 2020 to September 2021. Significant differences were considered when P &lt; 0.05. Results: The mean tracheal cuff pressure was improved post-intervention (49.2 ± 24.1 cm H2O versus 77.1 ± 31.1 cm H2O; P &lt; 0.001). A significantly higher proportion of tracheal cuffs (20%; 31/156) were inflated within the normal range compared to 6% (9/141) prior to the intervention (P = 0.003). Fewer patients developed post-operative sore throat following the educational intervention (32.8%; 41/125) versus pre-intervention (47.7%; 53/111; P = 0.019). Conclusion: The educational intervention improved the safety of tracheal cuff management, which could positively impact airway management, especially in poor resource settings without cuff manometers.

Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial

BackgroundTracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure.MethodsNinety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded.ResultsTracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81–1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04).ConclusionsCompared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

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.

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 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;

Tracheal complications of mechanical ventilation for COVID-19: a plot twist for survivors.

Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis. https://bit.ly/3iw05xQ.

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.

Tracheal tube cuff pressure during anesthesia for robotic-assisted laparoscopic prostatectomy and the efficacy of an automatic cuff pressure controller (SmartCuff): observational studies of 1-sample paired data.

The cuff pressure of a tracheal tube may increase during robot-assisted laparoscopic surgery for prostatectomy (RALP), which requires pneumoperitoneum in a steep head-down position, but there have been no studies which confirmed this. In study 1, we studied how frequently the cuff pressure significantly increased during anesthesia for the RALP. In study 2, we studied if the SmartCuff (Smiths Medical Japan, Tokyo) automatic cuff pressure controller would minimize the changes in the intracuff pressure. With approval of the study by the research ethics committee (approved number: 20115), we measured the cuff pressures in anesthetized patients undergoing RALP and in those undergoing gynecological laparotomy (as a reference cohort), with and without the use of the SmartCuff. In 21 patients undergoing RALP, a clinically meaningful increase (5 cmH2O or greater) was observed in all the 21 patients (P = 0.00; 95% CI for difference: 86-100%), whereas in 23 patients undergoing gynecological laparotomy, a clinically meaningful decrease (5 cmH2O or greater) was observed in 21 of 23 patients (91%, P < 0.0001; 95% CI for difference: 72-99%). With the use of the SmartCuff, there was no significant increase in the incidence of a clinically meaningful change in the intracuff pressure in either cohort. The cuff pressure of a tracheal tube would frequently increase markedly in patients undergoing RALP, whereas it would frequently decrease markedly in patients undergoing gynecological laparotomy. The SmartCuff may inhibit the changes in the cuff pressure during anesthesia.

A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial.

BackgroundSurgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.MethodsEighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence of postoperative sore throat and dysphonia.ResultsThe incidence of pressure adjustment after surgical retraction was significantly lower in the tapered group than in the control group (13% vs. 48%; P = 0.001; relative risk reduction, 74%). The median [interquartile range (IQR)] cuff pressure (mm Hg) was significantly lower for the tapered cuff than for the control cuff before surgical retraction [9 (7–12) vs. 12 (10–15); P < 0.001] and after retraction [18 (15–23) vs. 25 (18–31); P = 0.007]. The median (IQR) postoperative dysphonia score assessed by a single speech-language pathologist was lower in the tapered group than in the control group [4 (3–6) vs. 5.5 (5–7); P = 0.008].ConclusionA tapered cuff tracheal tube decreased the need for the adjustment of cuff pressure after surgical retraction during anterior cervical spine surgery, thereby avoiding intraoperative pressure increase. It also has a better outcome in terms of dysphonia.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT04591769].

The Elevation of Double-Lumen Tube Cuff Pressure During Lung Surgery: A Single-Center Prospective Observational Study☆,☆

Excessive tracheal tube cuff pressure can cause postoperative complications; however, the variations in the double-lumen tube cuff pressure in lung surgery have not been investigated. This study aimed to determine the incidence and variations in excess double- lumen tube cuff pressure during one-lung ventilation. A prospective observational study. Single secondary-care hospital. Patients aged ≥18 years scheduled for elective lung surgery using a left-sided double-lumen tube. None MEASUREMENTS AND MAIN RESULTS: Each cuff of the double-lumen tube was connected to a pressure transducer, and the cuff pressure was continuously measured. The excess cuff pressure and its duration (%) were defined as ≥22 mmHg, and the ratio of the duration of excess cuff pressure to the duration of one-lung ventilation, respectively. In total, 147 patients were included in the final analysis. Eighty patients (54.5%) developed cuff pressure elevation in either cuff and 28 patients (19%) in both cuffs. Younger age, male sex, and left-sided surgery were associated with elevated bronchial cuff pressure. Concurrently, younger age, maximal peak inspiratory pressure, and obstructive respiratory dysfunction were associated with an elevated tracheal cuff pressure. A duration of excess cuff pressure >50% in either cuff was found in 34 patients (23%), and both cuffs in 5 patients (3.4%). The correlation between the duration of tracheal and bronchial excess cuff pressure was poor. A high incidence and long duration of excess tracheal and bronchial cuff pressure were observed during one-lung ventilation for lung surgery.

Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country

BackgroundTracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria.MethodsThis was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 tertiary hospitals in Nigeria, selected by stratified random sampling.ResultsOnly 3.1% (6/196) of the care providers admitted having ever used a tracheal cuff manometer, while 31.1% knew the recommended tracheal cuff pressure. The nationwide telephone survey of anaesthesia faculty fellows revealed that tracheal cuff manometer is neither available, nor has it ever been used in any of the 13 tertiary hospitals surveyed. The ‘Pilot balloon palpation method’ and ‘fixed volume of air from a syringe’ were the most commonly utilized method of cuff pressure estimation by the care providers, at 64.3% and 28.1% respectively in part A survey (84.6% and 15.4% respectively, in the part B survey).ConclusionThe use of tracheal cuff manometer is very limited among the care providers surveyed in this study. Knowledge regarding tracheal cuff management among the providers is adjudged to be fair, despite the poor practice and unsafe care.

The effect of saline versus air for cuff inflation on the incidence of high intra-cuff pressure in paediatric MicroCuff® tracheal tubes: a randomised controlled trial.

The use of cuffed tracheal tubes in paediatric anaesthesia is now common. The use of nitrous oxide in anaesthesia risks excessive tracheal tube cuff pressures, as nitrous oxide can diffuse into the cuff during the course of surgery. The aim of this single-centre, prospective, randomised controlled trial was to compare the effect of saline versus air for the inflation of tracheal tube cuffs on the incidence of excessive intra-operative cuff pressure in children undergoing balanced anaesthesia with nitrous oxide. Children (age ≤16y) were randomly allocated to receive either saline (saline group) or air (air group) to inflate the cuff of their tracheal tube. The pressure in the tracheal tube cuff was measured during surgery and brought down to the initial inflation level if it breached a safe limit (25 cmH2 O). Post-extubation adverse respiratory events were noted. Data from 48 patients (24 in each group), aged 4months to 16y, were analysed. The requirement for reduction in intra-cuff pressure occurred in 1/24 patients in the saline group, compared with 16/24 patients in the air group (p<0.001). The incidence of extubation-related adverse events was similar in the saline and air groups (15/24 vs. 13/24, respectively; p=0.770). The use of saline to inflate the cuff of paediatric cuffed tubes reduces the incidence of high intra-cuff pressures during anaesthesia. This may provide a pragmatic extra safety barrier to help reduce the incidence of excessive tracheal cuff pressure when nitrous oxide is used during paediatric anaesthesia.

Response: Effect of Tracheal Intubation Mode on Cuff Pressure During Retractor Splay and Dysphonia Recovery after Anterior Cervical Spine Surgery

TO THE EDITOR: We thank Aggarwal et al for the letter on our article related to nasotracheal intubation in anterior cervical spine surgery (ACSS). The beginning paragraph provides the explanation for the longer surgical time in the nasotracheal intubation group. We compared the difference in the mean surgical time between the two intubation modes by using the independent t test. As comparison of two means can be partially influenced by the sample size and the distribution,1 we re-analyze the difference of median using Mann-Whitney U test and the P value is 0.068. Thus, the surgical time was not significantly different between the two groups. Finally, in the present study, there was no effect of surgical time on the improvement in dysphonia score after ACSSs, as previously demonstrated.2,3 Surgeon experience remains an important determinant of overall morbidity, and higher surgeon volume is associated with lower morbidity.4 Our patients were operated by the same surgeon (W-C.H.) and his team members, with a high surgeon volume. The team members with different levels of surgical experience were responsible for particular tasks in different stages of surgery. The main part of surgery was performed by Dr. Huang. Thus, factors related to the surgeon were controlled for in the study. Ever since Sperry et al5 revealed that the endotracheal tube cuff pressure (ETCP) increases significantly when surgical retractors are set up during ACSS, many studies have focused on the evaluation and adjustment of cuff pressure during surgery. Currently, many surgical teams, including our team, ensure the control of ETCP as the standard procedure of ACSS. In our study, the cause–effect relationship between tracheal tubes (ETT), tracheal tube cuff pressure, and post-ACSS dysphonia, or vocal cord palsy/paresis was based on evidence from Apfelbaum et al.6,7 First is the pressure from the endotracheal tube cuff. The splay of surgical retractors causes the extrusion of tissues (particularly the recurrent laryngeal nerve) between the tracheal tube cuff and the retractor blade.6 Second is the pressure from the tube. Compared with nasotracheal tube, the orotracheal tube is asymmetrically located in the thyroid cartilage and trachea due to fixation on one side of the mouth and causes uneven pressure on the vocal cord.7 The control of ETCP was performed as per our surgical procedure; thus, the complication may result from the tube per se. Another confounding factor affecting the outcome of nasotracheal intubation is the tube size. A small ETT is more often used during nasointubation than during orointubation. The use of a smaller ETT can alleviate a sore throat,8 but its effect on postoperative dysphonia or vocal cord palsy/paresis is yet being investigated. To verify study results, we replaced the reference group with the nasotracheal intubation group with an ETT size of >7. Patients in the orointubation group with an ETT size of >7 had higher dysphonia scores than did patients in the nasointubation group with an ETT size of >7 (estimated treatment effect = 1.22, P = 0.044), indicating less improvement (Table 1). Patients in the orointubation group with an ETT size of ≤7 also had higher dysphonia scores than did patients in the nasointubation group with an ETT size of >7 (estimated treatment effect = 2.49, P < 0.001). This means that orotracheal intubation, regardless of a larger or smaller tracheal tube, resulted in higher dysphonia scores and less improvement than nasotracheal intubation with an ETT size of >7. Based on the results, the tube size effect can be excluded in different tracheal intubation modes. Therefore, we can conclude that nasotracheal intubation has beneficial effects on voice recovery after ACSS, regardless of the tube size.TABLE 1: Mixed Effect Model of Improving Dysphonia Score After Anterior Cervical Spine SurgeryAt 30-day follow-up, 77 patients (71.3%) reported that they were satisfied with their voice recovery; 31 (28.7%) had varying degrees of dysphonia. Among dysphonic patients, six reported significant impact on their life, such as influence on a voice-dependent job, deprivation of singing habit, and, rarely but the worst, symptoms of choking or dyspnea. After consultation with ENT specialists, these patients were kept under observation for some time. The evidence of the effect of methylprednisolone on postoperative vocal cord palsy was weak9; therefore, it was not a routine medication for prophylaxis or treatment of post-ACSS dysphonia or vocal cord palsy in our patients. No patient received methylprednisolone perioperatively in the study.

Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Background and objectivesPoor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20−30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. MethodsProspective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. ResultsForty‐seven anesthesiologists were included in the study – 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cm H2O were, respectively, 52.5 (27.1) and 50 (30−70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. ConclusionThe subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study

Background and objectivesPoor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30cmH2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. MethodsProspective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. ResultsForty-seven anesthesiologists were included in the study – 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. ConclusionThe subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

The Changes of Endotracheal Tube Cuff Pressure during Manual and Intermittent Controlling in Intensive Care Units.

Background:Usually, the endotracheal tube cuff pressure is controlled by cuff pressure monitoring. However, the intermittent pilot-manometer connection and disconnection may cause a change in the adjusted pressure. This study aimed to investigate changes in the endotracheal tube cuff pressure using both manual and intermittent controls.Materials and Methods:A semi-experimental within-subject design was conducted. Fifty-nine intubated patients in the Mazandaran Intensive Care Units (ICUs) participated through convenience sampling in 2018. In the control condition, first, the cuff pressure was adjusted in 25 cm H2O then it was measured without manometer-pilot disconnection at 1 and 5 min intervals. In the intervention condition, cuff pressure was immediately adjusted in 25 cm H2O then it was measured with manometer-pilot disconnection in the 1st and 5th minutes. Data analysis was performed using Independent t-test, Chi-square test, and Phi coefficient.Results:The mean and Standard Deviation (SD) change of cuff pressure after 1 minute, from 25 cm H2O, in the intervention condition was 20.22 (3.53) cm H2O. The mean (SD) of this change in the control condition was 25.22 (3.39) cm H2O. This difference was significant (t116 = 7.83, p < 0.001, d = 1.44). The mean (SD) change of cuff pressure after 5 minutes, from 25 cm H2O, in the intervention condition was 19.11 (2.98) cm H2O. The mean (SD) of this change in the control condition was 25.47 (4.53) cm H2O. This difference was significant (t116 = 9.24, p < 0.001, d = 1.70).Conclusions:The tracheal tube cuff pressure has been significantly reduced during manual intermittent measuring. Therefore, it is suggested that continuous cuff pressure monitoring and regulation should be used.

High Tracheal Tube Cuff Pressure During Thyroidectomy is Associated with Recurrent Nerve Injury.

High Tracheal Tube Cuff Pressure During Thyroidectomy is Associated with Recurrent Nerve Injury.

Changes in Tracheal Tube Cuff Pressure and Recurrent Laryngeal Nerve Conductivity During Thyroid Surgery.

The aetiology of recurrent laryngeal nerve (RLN) neurapraxia is unclear in most RLN palsies post-thyroidectomy. We hypothesised that high intralaryngeal pressures impede RLN conductivity, in turn contributing to RLN palsy. Therefore, we measured tracheal tube (TT) cuff pressure (as a surrogate for intralaryngeal pressure) and RLN conduction during ten standard manoeuvres in thyroidectomy, to assess for correlation between cuff pressure and RLN conductivity. A prospective cohort study of thyroidectomy during 2018. For each thyroid lobe, TT cuff pressure was continuously measured via an air pressure transducer. RLN conduction (amplitude and latency) was measured using continuous neuromonitoring. Changes in mean TT cuff pressure and median nerve conduction from baseline measurements were analysed using Student's t test and Wilcoxon signed-rank test. In a total of 50 RLNs, the mean baseline TT cuff pressure of 19.5 ± 8.9mmHg increased significantly to 22.0mmHg during anteromedial rotation of the thyroid (p < 0.05). RLN conduction changed during manipulation of the superior thyroid pole with shortening of latency (-0.49% from baseline, p = 0.05) and reduction in amplitude (-12.0% from baseline, p = 0.02). The timing of these deviations did not correlate with the increased TT cuff pressure. In three cases of temporary RLN palsy, the mean cumulative case TT cuff pressure was significantly higher (24.8mmHg, p = 0.02). This study demonstrates that TT cuff pressure and RLN conductivity can change significantly with manipulation of the thyroid and that high TT cuff pressures may be associated with RLN injuries.

Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital.

Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventional component. In the final stage nurses completed a self-administered questionnaire. A total of 304 charts from 61 patients were reviewed. Patients' ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP. Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed. Basic knowledge of cuff pressure measurement may not always result in best practice.Improvement in current practice requires research into effective implementation strategies.