Comparison of Pressure Changes by Head and Neck Position between High-Volume Low-Pressure and Taper-Shaped Cuffs: A Randomized Controlled Trial

Abstract

The present study compared changes in cuff pressure by head and neck position between high-volume low-pressure (HVLP) and taper-shaped (taper) cuffs in a prospective randomized clinical trial. Methods. Forty patients were intubated using tracheal tubes with either HVLP (n = 20; HVLP group) or taper-shaped (n = 20; Taper group) cuffs. Initial cuff pressure was adjusted to 15, 20, or 25 cmH2O in the neutral position. Cuff pressure was evaluated after changing the head and neck positions to flexion, extension, and rotation. Results. Cuff pressure significantly increased with flexion in both HVLP and Taper groups at all initial cuff pressures. It significantly increased with extension in the HVLP group, but not in the Taper group. Cuff pressure did not significantly differ with rotation in either group and was significantly smaller in the Taper group during flexion and extension than in the HVLP group, regardless of initial cuff pressure. Conclusion. Cuff pressure changes with head and neck flexion and extension were smaller in the Taper group than in the HVLP group. Our results highlight the potential for taper cuffs to prevent excessive cuff pressure increases with positional changes in the head and neck. This trial is registered with UMIN000016119.

Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

“…Nevertheless, in our study, the median change in intracuff pressure was minimal-<3 cm H 2 O-and most patients (88%) still demonstrated intracuff pressures of 20-30 cm H 2 O after changing positions. This finding contrasts with that of Komosawa et al, they found that neck flexion and extension caused intracuff pressure to exceed 30 cm H 2 O with high incidences of 90% (flexion) and 50% (extension) [14]. One potential reason for our observations of stable intracuff pressure for the nasotracheal tube could be that nasotracheal tubes move less during posture changes than orotracheal tubes.…”

“…Our novel finding agrees with that of a prior study, intracuff orotracheal tube pressures are affected by head and neck positioning [14,17]. Komosawa et al found that, in adults, head flexion increased the intracuff pressure by a median of 10.3 cm H 2 O, head extension increased the pressure by a median of 5.0 cm H 2 O [14]. Additionally, in pediatric patients, Kako et al noted that neck flexion increased intracuff pressure with the greatest magnitude of mean 6.9 cm H 2 O [17].…”

“…In this study, the nasotracheal tube intracuff pressure changed significantly from the neutral to flexed, extended, and rotated neck positions. Our novel finding agrees with that of a prior study, intracuff orotracheal tube pressures are affected by head and neck positioning [14,17]. Komosawa et al found that, in adults, head flexion increased the intracuff pressure by a median of 10.3 cm H 2 O, head extension increased the pressure by a median of 5.0 cm H 2 O [14].…”

“…The primary outcome was the nasotracheal tube intracuff pressure. To determine the sample size, we estimated the intracuff pressure based on a previous report [14]. A sample size of 38 achieved 80% power to detect a mean of paired differences of 0.5 with an estimated standard deviation of differences of 0.9 and with an alpha of 0.016 using a two-sided paired t-test.…”

“…Moreover, intraoperative head and neck position changes are required in cases of surgery of several areas. The head and neck position can alter orotracheal tube intracuff pressure [13][14][15] since the airway's length and dimension changes with neck flexion, extension, and rotation. This can cause tube displacement and cuff compression or release [16][17][18].…”