An <i>in vitro</i> study of the compliance of paediatric tracheal tube cuffs and tracheal wall pressure

Bernet, Vera; Dullenkopf, Alexander; Cannizzaro, Vincenzo; Stutz, K.; Weiß, Markus

doi:10.1111/j.1365-2044.2006.04785.x

Cited by 11 publications

(14 citation statements)

References 23 publications

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“…After the heating period the ETT was immediately positioned with its cuffed end into the cock of a plastic syringe serving as a model for the trachea, a method that has been used by other authors before [3,4]. ETTs with an ID of 6.0 mm were put into a 10 ml syringe, and ETTs with an ID of 7.0 and 8.0 mm into a 20 ml syringe (Discardit II, Becton Dickinson, Fraga, Spain), respectively.…”

Section: Methodsmentioning

confidence: 99%

Cuff overinflation and endotracheal tube obstruction: case report and experimental study

Hofstetter

Scheller

Hoegl

et al. 2010

Scand J Trauma Resusc Emerg Med

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BackgroundInitiated by a clinical case of critical endotracheal tube (ETT) obstruction, we aimed to determine factors that potentially contribute to the development of endotracheal tube obstruction by its inflated cuff. Prehospital climate and storage conditions were simulated.MethodsFive different disposable ETTs (6.0, 7.0, and 8.0 mm inner diameter) were exposed to ambient outside temperature for 13 months. In addition, every second of these tubes was mechanically stressed by clamping its cuffed end between the covers of a metal emergency case for 10 min. Then, all tubes were heated up to normal body temperature, placed within the cock of a syringe, followed by stepwise inflation of their cuffs to pressures of 3 kPa and ≥12 kPa, respectively. The inner lumen of the ETT was checked with the naked eye for any obstruction caused by the external cuff pressure.ResultsNeither in tubes that were exposed to ambient temperature (range: -12°C to +44°C) nor in those that were also clamped, visible obstruction by inflated cuffs was detected at any of the two cuff pressure levels.ConclusionsWe could not demonstrate a critical obstruction of an ETT by its inflated cuff, neither when the cuff was over-inflated to a pressure of 12 kPa or higher, nor in ETTs that had been exposed to unfavorable storage conditions and significant mechanical stress.

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Section: Methodsmentioning

confidence: 99%

Cuff overinflation and endotracheal tube obstruction: case report and experimental study

Hofstetter

Scheller

Hoegl

et al. 2010

Scand J Trauma Resusc Emerg Med

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“…We placed Parker Flex-Tip™ tracheal tubes of the high-volume low-pressure cuffed type with an internal diameter (ID) of 5.0 mm (Parker tube; Parker Medical, Highlands Ranch, CO, USA, International product number: I-PFHV-50) into a tracheal model consisting of an acrylic cylinder with ID of 12 mm to simulate an approximately 8-year-old patient. [ 12 , 13 ] We also used Parker Flex-Tip™ tracheal tubes of the preformed oral cuffed type with ID of 4.0 mm (International product number: I-PFOC-40) and an acrylic tracheal model with ID of 9 mm to simulate an approximately 4-year-old patient. The cuffs of the both tracheal tubes are made of polyvinyl chloride (PVC) and have similar cylindrical shapes.…”

Section: Methodsmentioning

confidence: 99%

Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube

et al. 2017

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BackgroundLubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study.MethodsWe placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmH2O and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmH2O and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen.ResultsFor both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15–35) cmH2O. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15–25) and 15 (15–35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15–35) cmH2O. Water application did not change these outcomes compared with the N group.ConclusionPre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.

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“…Pediatric tracheal tube cuffs restricted in the small trachea of children usually require only a little amount of air to effectively seal the airway [30]. Simple syringe inflation often leads to hyperinflation of pediatric tube cuffs.…”

Section: Cuff Pressure Controlmentioning

confidence: 99%

“…In contrast to cricoidal sealing, tracheal sealing allows the estimation and adjustment of the pressure exerted by the cuff to the tracheal mucosa. This pressure can be kept within assumingly safe limits, when a high volume-low pressure (HVLP) cuff is issued [30].…”

Section: New Anatomical Data Demonstrate That the Cricoid Lumen Is Nomentioning

confidence: 99%

Cuffed tracheal tubes in children: past, present and future

Weiß¹,

Dullenkopf

2007

Expert Review of Medical Devices

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This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.

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An in vitro study of the compliance of paediatric tracheal tube cuffs and tracheal wall pressure

Cited by 11 publications

References 23 publications

Cuff overinflation and endotracheal tube obstruction: case report and experimental study

Cuff overinflation and endotracheal tube obstruction: case report and experimental study

Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube

Cuffed tracheal tubes in children: past, present and future

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