Tube Cuff Research Articles

Implementation of a Volume-Based Technique for Endotracheal Tube Cuff Inflation: A Quality Improvement Project

Background:The goal of endotracheal tube (ETT) cuff inflation is to produce a pressure within the range of 20–30 cm H2O to ensure a proper seal against the trachea without compromising mucosal perfusion. The gold standard for the assessment of ETT cuff pressure is a handheld manometer; however, due to a lack of availability, this is rarely performed. Using a 10-mL syringe for cuff inflation is a common practice but can lead to overinflation and higher-than-recommended pressures.Objective:The purpose of this quality improvement project was to evaluate the incidence of ETT cuff overinflation and determine if an educational intervention advocating for lower volumes would reduce the occurrence.Method:The authors evaluated 50 ETT cuff pressures before and 50 after an educational intervention proposing the use of a 5-mL syringe for cuff inflation rather than a 10-mL syringe.Results:Median cuff pressure significantly decreased from 60 cm H2O in the preintervention phase to 30 cm H2O in the postintervention phase using 5-mL syringes, a 50% decrease (p< .001).Conclusion:This project demonstrated that an educational presentation recommending a 5-mL syringe for ETT cuff inflation resulted in a significant reduction of cuff pressures.Implications for Nursing:Nurse anesthetists should be aware of the risk of overinflation of endotracheal tube cuffs. Implementing a volume-based inflation method into current practice will decrease this incidence and the harmful sequelae associated with high cuff pressure.

Endotracheal Tube Cuff Inflation Methods in School-Age Children: Flow-Volume Loop-Guided Versus Stethoscope-Guided

Endotracheal Tube Cuff Inflation Methods in School-Age Children: Flow-Volume Loop-Guided Versus Stethoscope-Guided

Development of a Circumallergenic Guayule Latex Endotracheal Tube Cuff

Abstract Endotracheal tube (ETT) cuffs made from soft, hypoallergenic guayule latex placed outside existing polyvinyl chloride (PVC) cuffs were previously developed as an alternative to PVC cuffs alone. Although these outer cuffs do not cross-react with Type I latex allergy, they were made using conventional vulcanization chemicals which can cause adverse contact reactions. New outer cuffs have been made with guayule latex using a xanthate-based accelerant system designed to avoid contact reactions and create a perfect seal with the patient’s trachea. A standard formula was used for compounding, and concentrations of all components remained constant except for two hypoallergenic accelerants: diisopropyl xanthogen polysulphide (DIXP), added in concentrations of either 2.0 or 2.2 parts per hundred rubber (phr), and zinc diisononyl dithiocarbamate (ZDNC), added in concentrations of 0.6, 0.8, or 1.0 phr. Samples were dipped at dwell times of 5 or 15 s for thickness variation. Cured samples underwent tensile testing 14 days after creation. Benchtop leak tests were conducted using a standard PVC cuff with three simulated trachea sizes. Additional leak tests were performed using the guayule latex cuffs and a 20 mm inner diameter tube. A combination of 2.0 phr DIXP and 0.6 phr ZDNC resulted in the highest tensile strength in both thin and thick cuffs. The lowest modulus values occurred at 2.0 phr DIXP and 0.8 ZDNC for thinner samples and 2.2 phr DIXP and 1.0 phr ZDNC for thicker samples. The two-way ANOVA for the double cuff leak test revealed no significant effect of accelerant concentration on leakage rate (P = 0.5783). Finally, varying the size of the simulated trachea for the PVC cuffs revealed that larger tracheas had lower average leak rates. All guayule latex double cuffs prevented leakage consistently. The samples made using a combination of 2.0 phr DIXP and 0.6 phr ZDNC had the most ideal mechanical properties (softness, stretchiness, and strength) for the creation of a guayule latex ETT balloon cuff. The decreased leakage rate of the PVC cuff in the larger simulated tracheas was due to the increased room for cuff expansion, reducing the number of longitudinal folds.

Lidocaine vs. Mometasone Furoate Around the Pediatric Tracheal Tube Cuff: Hemodynamic Stress Response and Postoperative Airway Complications: A Prospective, Randomized, Controlled Study

Lidocaine vs. Mometasone Furoate Around the Pediatric Tracheal Tube Cuff: Hemodynamic Stress Response and Postoperative Airway Complications: A Prospective, Randomized, Controlled Study

Reevaluating 30 cmH2O endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation.

The optimal endotracheal tube (ETT) cuff pressure remains contentious. In the traditional consideration that the level 30 cmH2O is considered safe, balancing the prevention of reflux aspiration against airway mucosal damage. Whether this pressure level can cause potential damage to the airway mucosa remains to be discussed. Airway mucosa damage and structural changes at 30 cmH2O were examined in patients under general anesthesia and in rabbit mechanical ventilation models. Prior to this, we also interviewed some anesthesiologists about the level of concern about ETT cuff pressure. A total of 634 valid questionnaires suggested that anesthesiologists generally do not pay enough attention to ETT cuff pressure and the average established cuff pressure significantly exceeded 30 cmH2O. Airway mucosa images of 100 general anesthesia patients with different ventilation duration indicated that maintaining the pressure at 30 cmH2O did not cause significant damage to airway mucosa in a short period of time, while it still caused damage to airway mucosa in patients with long-term ventilation, with damage severity increasing with longer ventilation periods. This correlated strongly with postoperative sore throat (R 2 = 0.3884, p < 0.001). In rabbits, 4 h of ventilation at this pressure resulted in significant loss of ciliated epithelium and inflammation. Calculations suggested an effective dose (ED50) to prevent mucosal injury at a cuff pressure of 25.64 cmH2O (95% CI: 19.268-29.367 cmH2O). The currently established cuff pressure of 30 cmH2O is associated with airway mucosal damage in both clinical and animal models. Lowering the safety threshold of cuff pressure may be necessary to mitigate mucosal injury.

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

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.

A rare case of endotracheal tube cuff leakage with no detectable decrease in cuff pressure

BackgroundCommon causes of air leakage around an endotracheal tube include insufficient endotracheal tube cuff inflation and damage to the cuff, while damage to the pilot balloon or pilot balloon tubing is relatively rare.Case presentationA 74-year-old female with vertebral osteomyelitis was scheduled for an extreme lateral interbody fusion followed posterior fixation. A fiber-optic light was utilized as part of the surgical illuminator. A sudden decrease in tidal volume and airway pressure was noted intraoperatively. We suspected leakage around the endotracheal tube cuff; however, no decrease in cuff pressure was detected. Despite the normal cuff pressure, we decided to inject a small amount of air which led to a significant increase in the cuff pressure. Upon careful inspection of the endotracheal tube, we discovered that the pilot balloon tubing was damaged as a result of thermal energy emitted by the fiber-optic light, which had ignited the surgical drape. The pilot balloon tubing was partially severed in which the section proximal to the endotracheal tube cuff was burned and punctured, causing the cuff leak. Meanwhile, the section proximal to the pilot balloon had melted and occluded the lumen, resulting in a falsely normal cuff pressure reading followed by an elevated cuff pressure when a small amount of air was injected into the pilot balloon during troubleshooting. Appropriate ventilation was resumed after extubation and re-intubation with a new endotracheal tube.ConclusionsWe experienced an endotracheal tube cuff leakage caused by a damaged pilot balloon tubing due to thermal energy of the fiber-optic light. Our case report emphasizes the importance of suspecting damage to the endotracheal tube cuff and inflation system despite a normal cuff pressure reading, given that the measurement may be falsely elevated depending on the specific location of the damage. In addition, all operating personnel should be familiarized with safety warnings and cautions related to handling.

The evaluation of endotracheal tube cuff pressure in pediatric patients by subjective inflation techniques: a prospective observational study.

Cuffed endotracheal tubes (ETTs) are commonly used in pediatric patients, with the gold standard for measuring cuff pressure being a cuff pressure manometer. However, this equipment is not always available in every operating room. Subjective inflation techniques, such as the minimal occluding volume (MOV) technique and the stethoscope-guided (Steth) technique, offer convenient and safe alternatives to standard methods but do not provide quantitative measurements. This study aimed to evaluate ETT cuff pressures and volumes of air inflated using the two subjective techniques (MOV and Steth) in pediatric patients. This prospective observational study was conducted at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Thailand. We included healthy pediatric patients aged 2 to 7 years undergoing elective surgeries under general anesthesia with a cuffed ETT. The primary objective of this study was to compare the mean ETT cuff pressures and volumes of air inflated using the two subjective inflation techniques (MOV and Steth method). The secondary objectives include identifying factors associated with inappropriate inflation and evaluating post-intubation complications. Sixty-four pediatric patients were analyzed. The overall mean ETT cuff pressure was 26.52 ± 8.68 cmH2O. The target was achieved in 46.88% of patients, with overinflation in 32.81% and underinflation in 20.31%. The mean ETT cuff pressure in the MOV group was 27.77 ± 8.89 cmH2O and in the Steth group was 25.33 ± 8.34 cmH2O, with a non-significant mean difference of 2.44 cmH2O (95% CI [-1.89, 6.77], p = 0.264). The mean volume of air inflated in the MOV group was 0.78 ± 0.25ml, and in the Steth group was 0.68 ± 0.22ml, with a non-significant mean difference of 0.10ml (95% CI [-0.01, 0.22], p = 0.084). Younger age, lower weight, and shorter height were significantly associated with an increased risk of overinflation. An ETT size with an internal diameter (ID) of 5mm was significantly associated with an increased risk of underinflation. No post-intubation complications were reported. Subjective inflation techniques (MOV or Steth) achieve target ETT cuff pressures in less than 50%, and carry the risks of both overinflation and underinflation,even without post-intubation complications. TCTR20211016001 (registered with the Thai Clinical Trials Registry on October 16, 2021).

Endotracheal Tube Cuff Pressure Changes in Mechanically Ventilated Patients Undergoing General Anaesthesia with O2, N2o &amp; Other Inhalation Agents in Elective O. T. &amp; in Intensive Care Unit Set-Up with O2 and Air - A Prospective Observational Study

Endotracheal Tube Cuff Pressure Changes in Mechanically Ventilated Patients Undergoing General Anaesthesia with O2, N2o &amp; Other Inhalation Agents in Elective O. T. &amp; in Intensive Care Unit Set-Up with O2 and Air - A Prospective Observational Study

Tracheostomy Cuff Herniation following Cardiac and Pulmonary Arrest

Tracheostomy is a common procedure performed on patients who require long-term airway maintenance and ventilation support. It is preferred over endotracheal intubation due to its reduced airway resistance, lower risk of displacement compared with the endotracheal tube, increased patient comfort, improved weaning from mechanical ventilation, and enhanced suction capabilities. According to the literature, patients needing airway support for fewer than 12 days can undergo translaryngeal intubation, while tracheostomy is indicated for patients requiring ventilatory support for more than 20 days. Although tracheostomy is frequently performed in ICUs and operating rooms, several complications can arise following the procedure. These complications include leakage, obstruction of the tracheal tube, minor or major bleeding or oozing, barotrauma, infections, tracheoesophageal fistula, stenosis, and injury to surrounding peripheral tissues such as arteries, veins, and nerves.1 While herniation of the endotracheal cuff is a more common cause of airway obstruction and hypoxia, tracheostomy tube cuff herniation is a rare complication of this procedure.1-7 In this report, we present a rare case of cardiopulmonary arrest following the implantation of a tracheostomy tube cuff in a female patient and its management.

Success rate of nasogastric tube insertion in anesthetized, intubated, adult patients: A comparison between endotracheal tube cuff inflated and deflated states

Success rate of nasogastric tube insertion in anesthetized, intubated, adult patients: A comparison between endotracheal tube cuff inflated and deflated states

Kaf İçi ve Dışına Lidokain Uygulamasının Ekstübasyon Sonrası Görülen Kardiyovasküler ve Solunum Sistemi Yanıtlarına Etkileri

Objective: In our investigation, we aimed to assess the efficacy of employing lidocaine spray application around endotracheal tube cuff (ETTC) prior to intubation, alongside and the use of intracuff lidocaine application following intubation. Our primary objective encompassed an examination of the resultant effects on the cardiovascular and respiratory systems leading up to the extubation phase. Methods: Two hundred patients scheduled for gynecologic operations, with an ASA physical status of I or II and aged between 18 and 65 years, undergoing general anesthesia lasting over one hour, were recruited for the study. Patients were allocated into four groups. Group I involved the inflation of the endotracheal tube cuff with air following intubation. In Group II, 10% lidocaine was sprayed around the ETTC prior to intubation. Group III entailed the inflation of the ETTC with 2% lidocaine after intubation. Lastly, Group IV received both the pre-intubation application of 10% lidocaine spray around the ETTC and the inflation of the cuff with 2% lidocaine following intubation. Cardiovascular parameters in the early post-extubation period and occurrences of postoperative sore throat, cough, and hoarseness up to 48 hours post-operation were documented for analysis. Results: Increases were observed at cardiovasvular system parameters after extubation in all groups continued for 5 or 15 minutes. Postoperative data for sore throat, cough and hoarseness were smilar in all groups. Conclusion: The study revealed that the administration of 10% lidocaine spray around the ETTC, as well as the use of 2% lidocaine within the cuff alone or in combination, did not result in a reduction of cardiovascular system responses during the early post-extubation period. However, these interventions did lead to a decrease in postoperative respiratory system side effects, albeit not providing complete prevention of such occurrences. Keywords: Lidocaine, endotracheal tube cuff, extubation, hemodynamic, pulmonary

Lubrication of endotracheal tube cuffs reduces gas leakage during positive pressure ventilation

Lubrication of endotracheal tube cuffs reduces gas leakage during positive pressure ventilation

Endotracheal Tube Cuff Deflation Methods Reduce Stress Response and Incidence of Postoperative Pharyngeal Complications in Patients Treated with Gynecological Laparoscopic Surgery.

This study aims to explore the impact of endotracheal tube cuff deflation methods on extubation stress responses and postoperative pharyngeal complications in patients treated with gynecological laparoscopic surgery. In this study, retrospective clinical data of 94 patients treated with gynecological laparoscopic surgery under general anesthesia in Northwest Women's and Children's Hospital from June 2023 to June 2024 were collected and analyzed. Patients were assigned into two groups based on the cuff deflation methods used after anesthesia: Group A (45 patients) adopted a one-time deflation method, while Group B (49 patients) employed a gradual deflation method. Surgery-associated indicators were recorded, with heart rate (HR), mean arterial pressure (MAP), rate pressure product (RPP), epinephrine (E), norepinephrine (NE), and cortisol (Cor) levels monitored at selected time points: before cuff (T0), immediately after extubation (T1), 1 minute post-extubation (T2), 5 minutes post-extubation (T3), and 10 minutes post-extubation (T4). The incidence of pharyngeal complications was also compared between the two groups. Compared with Group A, Group B displayed smaller variations in HR, MAP, and RPP at T1, T2, and T3 (p < 0.05). Group B also showed smaller variations in E, NE, and Cor levels at T2, T3, and T4 in contrast with Group A (p < 0.05). The incidence of complications such as coughing, sore throat, and hoarseness was conspicuously attenuated in Group B compared to Group A (6.12% vs 22.22%, p < 0.05). Gradual deflation of the endotracheal tube cuff dramatically ameliorates extubation stress responses, stabilizes hemodynamics, and alleviates pharyngeal discomfort in patients treated with gynecological laparoscopic surgery.

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

A Comparative Study of Cuff Pressure and Its Pressure Effects on the Incidence of Postoperative Cough, Sore Throat and Hoarseness between Air and Alkalinized Lignocaine for Inflating Endotracheal Tube Cuff in Non-Cardiac Surgeries Under General Anaesthesia

A Comparative Study of Cuff Pressure and Its Pressure Effects on the Incidence of Postoperative Cough, Sore Throat and Hoarseness between Air and Alkalinized Lignocaine for Inflating Endotracheal Tube Cuff in Non-Cardiac Surgeries Under General Anaesthesia

Effectiveness of lidocaine as an endotracheal tube (ETT) cuff inflating agent: A single center experience

Effectiveness of lidocaine as an endotracheal tube (ETT) cuff inflating agent: A single center experience

Optimizing patient safety: Unveiling the significance of cuff pressure in anaesthesia

BackgroundInadequate pressure in the endotracheal tube (ETT) cuff can lead to compromised ventilation or airway injury. Accurate assessment of ETT cuff pressure is essential and should be performed using a manometer, with an optimal target range of 20–30 cmH2O. AimIn this study, we aimed to audit ETT cuff pressures in the operating theatre of our institution, utilizing a manometer from VBM Medizintechnik GmbH™. MethodsFollowing approval from the ethics committee, we conducted an audit from January 2023 to November 2023. A convenience sample was utilized, including adult patients who were intubated in our operating rooms (ORs) during either the morning or afternoon shifts at the time of the audit. ResultsA total of 49 patients were evaluated. Our findings revealed that 78 % of the patients had cuff pressures outside the recommended target range, with recorded pressures ranging from 18 cmH2O to 120 cmH2O, and a mean pressure of 63 cmH2O. Nitrous oxide was not used in any of the cases. Cuff inflation was performed using different syringe volumes: a 5 mL syringe was used in one case, a 10 mL syringe in 20 cases, and a 20 mL syringe in 28 cases, with a mean inflation volume of 9 mL. Statistical analysis indicated no significant difference in ETT cuff pressure related to the type of syringe used or the size of the endotracheal tube. Additionally, no correlation was found between the volume of air used for cuff inflation and the resulting ETT cuff pressure. ConclusionOur audit revealed that only 22 % of the patients had cuff pressures within the recommended limits, highlighting a significant need for increased awareness and education. As maintaining appropriate cuff pressure is a standard of care, systematic implementation of reliable cuff pressure monitoring is strongly recommended.

Alkalized lidocaine in endotracheal tube cuff inflation in patients undergoing thyroidectomy surgery: a clinical trial.

The aim of the study was to compare the postoperative effects of endotracheal tube cuff inflation with alkalized lidocaine in patients undergoing thyroidectomy surgery. This is a randomized, double-blind clinical trial between August 2020 and August 2022 at the Hospital São Domingos, São Luís, Maranhão, Brazil. Patients over 18 years who underwent thyroidectomy of both sexes, American Society of Anesthesiologists (ASA) I or ASA II, were included. Patients with difficult orotracheal intubation, smoking, cuff rupture during orotracheal intubation, heart, lung, or neuropathies, previous surgery of the larynx or trachea, with risk of aspiration of gastric contents, or with the need to use a nasogastric tube were excluded. Patients were randomly selected and divided into the control group, whose cuff was filled with 0.9% saline solution, and the alkalinized lidocaine group, where the cuff was filled with 2% lidocaine and 8.4% sodium bicarbonate. The control group had higher systolic blood pressure [137 (94-183) mmHg] medians after extubation than the alkalinized lidocaine group [127 (82-189) mmHg] (p=0.03). The same was observed in heart rate values [control group: 86 (62-120); alkalinized lidocaine group: 80 (53-120)] (p=0.034). The alkalinized lidocaine group showed a significant increase in the ability to sustain phonation in the 24 h postoperatively, from 82.0 to 98.0% (p=0.031). There was no protective effect of the use of alkalinized lidocaine on the sensation of swallowing and complaints after thyroidectomy surgery. There was a significant improvement in hemodynamic response in the intervention group after extubation.