Tube Cuff Pressure In Patients Research Articles

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).

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.

The Effect of Different Body Positions on Endotracheal Tube Cuff Pressure in Patients under Mechanical Ventilation.

Introduction: Maintaining endotracheal tube intracuff pressure (ETTICP) within an optimal range is crucial for effective ventilation and prevention of aspiration. This study aimed to determine the effect of changing body position on ETTICP in patients under mechanical ventilation.Methods: In the current single-group study, each patient was taken as his/her own control. Thirty patients who met the inclusion criteria were selected as the study sample. First, the patients were placed in a supine (flat) position, head of the bed was raised to 30 degrees, and ETTICP was set at 25 cmH2 O as the baseline. Then, the ETTICP changes in the three positions (left lateral, right lateral, and semi-fowler) were compared with the baseline. Interventions were made on a random basis among the patients. Data were analyzed by repeated-measures ANOVA using SPSS version 13.Results: There was a significant difference among ETTICP means in three different body positions, so that ETTICP was higher in the left lateral position compared to other positions. Moreover, there was a significant difference among ETTICP means 0, 15, 45, and 90 minutes after changing the body position. ETTICP means after 0 and 15 minutes were significantly higher than other times compared to the baseline.Conclusion: ETTICP changes were affected by different body positions and the passage of time. Thus, regular monitoring and adjusting of ETTICP after any body positioning is essential, especially immediately and 15 minutes after repositioning.

Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport.

IntroductionEndotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS.MethodsWe enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool.ResultsWe analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge.ConclusionPatients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.

Performance comparison of a new automated cuff pressure controller with currently available devices in both basic research and clinical settings.

BackgroundThe management of tracheal tube cuff pressure in patients receiving mechanical ventilation is important for the prevention of ventilator-associated pneumonia. Currently, cuff pressure is intermittently monitored with a pressure gauge and adjusted when necessary in a routine practice. However, this method results in wide variations in pressure, and adequate management is difficult due to the spontaneous release of air from the cuff, which reduces cuff pressure. In order to continuously maintain a uniform cuff pressure, we developed a new automated cuff pressure controller and compared its properties with existing devices.MethodsThe effectiveness of the new device was assessed with a model trachea/lung and tracheal tube by measuring cuff pressure while on mechanical ventilation. An electrically powered automatic cuff controller or manual cuff pressure control was used for comparison purposes. The effectiveness of the new device was also examined in patients receiving mechanical ventilation by continuously measuring cuff pressure for a 24-h period.ResultsCuff pressure was uniformly maintained with the new device. Moreover, in the clinical setting, variation in pressure from the set pressure was minimal with both the new device and existing device, relative to the intermittent monitoring method. This suggests that, as with the existing device, uniform cuff pressure management is possible with the new device.ConclusionsOur results demonstrate the ability of the new cuff pressure controller to manage cuff pressure without the need of a power source, highlighting its potential utility in clinical settings.

Oral Endotracheal Tube Cuff Pressure in Patients Undergoing Mechanical Ventilation Admitted to the Intensive Care Unit

Oral Endotracheal Tube Cuff Pressure in Patients Undergoing Mechanical Ventilation Admitted to the Intensive Care Unit

145 Endotracheal Tube Cuff Pressures in Patients Intubated by Referral Agencies in a Helicopter EMS System

145 Endotracheal Tube Cuff Pressures in Patients Intubated by Referral Agencies in a Helicopter EMS System

Ethics, equipoise, and evidence: when should investigators decide to not test their hypothesis

In an excellent investigation of endotracheal tube cuff pressure assessment, “Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Transport,” Chapman et al measured endotracheal tube cuff pressure in patients who arrive at their emergency department after being intubated in the field. This, the first published American study of this type, presents clear and convincing evidence that patients who undergo endotracheal intubation before transport have endotracheal tube cuff pressures that exceed safe limits. Although a study of this type has not been conducted on patients who are endotracheally intubated by emergency medicine physicians within the confines of an emergency department, we pose the question to the academic and clinical emergency medicine community, “Should such a study be conducted?” Instead, should the evidence offered by Chapman et al, in addition to that of other publications, be enough to prompt emergency physicians to abandon the practice of endotracheal intubation without measurement and/or control of endotracheal tube cuff pressure? To adequately understand the complexity of such an apparently simple question, it is necessary to consider 2 concepts: equipoise and evidence. Our hope is that readers will acknowledge the study of Chapman et al as a strong piece of evidence indicating that patients who undergo endotracheal intubation without measurement of endotracheal tube cuff pressure very likely have a pressure that exceeds the safe range. We hope this study, in conjunction with the other available evidence, will prompt readers to adopt measurement of endotracheal tube cuff pressure as a routine.

Endotracheal tube cuff pressures in patients intubated before transport

Introduction Prolonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H 2O cause complications ranging from sore throat to rare cases of tracheoesophageal fistula. In a series of patients, we sought to determine the proportion of patients with overinflated cuffs and to determine whether overinflation was associated with demographics, diagnostic category, or intubator credentials. Methods Between July 2007 and April 2008, we measured cuff pressures on a convenience sample of patients drawn from 2 groups. The “helicopter group” had pressure measured before transport by a single aeromedical transport service. The “hospital group” had pressure measured upon arrival to 1 of 2 emergency departments after being intubated before transport. Results Three hundred patients aged 4 to 92 years (median, 57) were studied: 59.7% were male; and diagnostic categories were neurologic (33.7%), trauma (32.7%), cardiac (12.7%), and general medical/surgical (21.0%). Intubation occurred 1 to 28 000 minutes before ETTCP assessment (median, 60). Endotracheal tube cuff pressure was greater than 30 cm H 2O in 64.7% and ranged from 10 to 180 (median, 40). Forty-nine percent of patients had ETTCP greater than 40 cm H 2O. There was no association between ETTCP and age group, sex, diagnostic category, ETT size, time between intubation and ETTCP assessment, or intubator credentials. Conclusions The most compelling results of the study are the high rates of elevated ETTCPs. Furthermore, there were no clear risk factors for elevated ETTCP. Although the risk of elevated ETTCP in the prehospital to acute care time frame is unclear, it seems reasonable to measure ETTCP after intubation in all patients.

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.

Monitoring of tracheal tube cuff pressure in patients treated in intensive therapy unit and intensive care units

Monitoring of tracheal tube cuff pressure in patients treated in intensive therapy unit and intensive care units