Assessment of a New Method to Distinguish Esophageal from Tracheal Intubation by Measuring the Endotracheal Cuff Pressure in a Porcine Model

Hsu, Chien Chin; Lee, Wei Jing; Wu, Yen Liang; Guo, How‐Ran; Lin, Hung Jung

doi:10.1197/j.aem.2005.07.019

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…Exclusion criteria included subject refusal, emergency surgery, increased risk of aspiration, known or expected difficult intubation, contraindication to the use of succinylcholine, and a history of esophageal or tracheal pathology. The study protocol was formulated by combining key aspects of the previous studies performed on porcine models [15,16] and human cadaveric subjects [17], as well as integrating standard patient intubation techniques and monitoring to ensure amnesia, analgesia, and muscular relaxation during our study.…”

Section: Methodsmentioning

confidence: 99%

“…Based on data from the porcine study [15], a power analysis was performed. At a 4-mL cuff volume, a difference in cuff pressure between esophageal and tracheal locations of 20±2 Mean intrinsic esophageal and tracheal cuff pressures for females and males are represented graphically in (Figures 1 and 2).…”

Section: Methodsmentioning

confidence: 99%

“…Using a porcine model, Hsu et al, demonstrated a very large difference in cuff pressures, with esophageal cuff pressure exceeding tracheal cuff pressure measured throughout cuff inflation [15]. However, the animals were placed in a dorsal recumbent position and were not paralyzed.…”

Section: Cuff Volume (Ml)mentioning

confidence: 99%

“…Measuring the pressure exerted within the cuff of an endotracheal tube could be a novel and accurate method of confirming proper tube placement. Recent studies performed in porcine models (anesthetized, non-paralyzed pigs [15] and ex vivo porcine tracheal-esophageal tissue preparations [16]) explored this method of confirming endotracheal tube placement. Both studies found that a curvilinear relationship existed between cuff volume and pressure in the tracheal location with an exponential increase in pressure at high cuff volumes.…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing esophageal from endotracheal intubation by measuring endotracheal tube cuff pressure

Goentzel¹,

Larsen²,

Shelburne³

et al. 2013

Emerg Med Health Care

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Background: It is unknown whether measuring endotracheal tube cuff pressure can accurately confirm tracheal intubation. Animal and human cadaveric studies show conflicting results. In anesthetized patients, we tested the hypothesis that the pressurevolume characteristics of the cuff located in the trachea would differ from that measured in the esophagus potentially making cuff pressure a useful tool to distinguish esophageal from tracheal intubation. Methods: Thirty-four female and 35 male patients undergoing general anesthesia were intubated under direct laryngoscopy with 7.0 mm and 8.0 mm cuffed tubes, respectively, first in the esophagus and next in the trachea. Cuff pressures at each site were recorded during sequential one mL inflation volumes up to 10 mL or when cuff pressure exceeded 250 mmHg and compared using the Wilcoxon signed rank test. Results: In females, tracheal cuff pressure significantly exceeded esophageal cuff pressure at all volumes between 3 and 10 mL (p<0.05) but with a large degree of interpatient variability. In contrast, male esophageal cuff pressure exceeded tracheal cuff pressure at volumes less than 3 mL and did not differ between the two sites at higher cuff volumes. Conclusions: In female patients, greater cuff pressures in the tracheal than esophageal location are attributed to the influence of less compliant cartilaginous rings. These findings were not replicated in male patients. However, the large degree of variability precludes the clinical application of this technique for accurate identification of cuff location in the trachea.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Cuff Volume (Ml)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Distinguishing esophageal from endotracheal intubation by measuring endotracheal tube cuff pressure

Goentzel¹,

Larsen²,

Shelburne³

et al. 2013

Emerg Med Health Care

View full text Add to dashboard Cite

show abstract

Immediate injection pain in infants aged 18 months during vaccination against measles, mumps and rubella with either Priorix® or MMR-II®

Knutsson¹,

Jansson

Alm

2006

Vaccine

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An original design of remote robot-assisted intubation system

Wang

Tao

et al. 2018

Sci Rep

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The success rate of pre-hospital endotracheal intubation (ETI) by paramedics is lower than physicians. We aimed to establish a remote robot-assisted intubation system (RRAIS) and expected it to improve success rate of pre-hospital ETI. To test the robot’s feasibility, 20 pigs were intubated by direct laryngoscope or the robot system. Intubation time, success rate, airway complications were recorded during the experiment. The animal experiment showed that participants achieved a higher success rate in absolute numbers by the robot system. In summary, we have successfully developed a remote robot-assisted intubation system. It is promising for RRAIS to improve the success rate of pre-hospital ETI and change the current rescue model.

show abstract

Assessment of a New Method to Distinguish Esophageal from Tracheal Intubation by Measuring the Endotracheal Cuff Pressure in a Porcine Model

Abstract: The cuff pressure in the esophageal intubation was significantly higher than that in the endotracheal intubation under the same inflated volume from 1 to 10 mL. This may provide the basis for an adjunctive, simple, rapid, and reliable method to verify endotracheal intubation.

Cited by 5 publications

References 31 publications

Distinguishing esophageal from endotracheal intubation by measuring endotracheal tube cuff pressure

Distinguishing esophageal from endotracheal intubation by measuring endotracheal tube cuff pressure

Immediate injection pain in infants aged 18 months during vaccination against measles, mumps and rubella with either Priorix® or MMR-II®

An original design of remote robot-assisted intubation system

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