Detection of oesophageal intubations using cuff pressures in a pig trachea–oesophagus model

Abstract

We conclude that the cuff pressures may be useful in detecting oesophageal intubations. This method is faster than other confirmation measures as it can detect inadvertent oesophageal intubations at the time of inflating the cuffs.

Distinguishing esophageal from endotracheal intubation by measuring endotracheal tube cuff pressure

“…However, the animals were placed in a dorsal recumbent position and were not paralyzed. The same laboratory repeated the study using tracheal-esophageal tissue preparations harvested from adult pigs with similar conclusions [16]. Using a human cadaveric model, Russo et al, found conflicting results with esophageal and tracheal pressures demonstrating no significant difference with cuff volumes exceeding 3 mL [17].…”

“…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.…”

“…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.…”

Comparison of Tracheal and Esophageal Compliance Curves in Human Cadaveric Subjects

“…Structural differences in the trachea and esophagus provide a differential compliance during cuff inflation as demonstrated in porcine models. 1,2 This could be the basis of a new method of rapidly and accurately confirming tube placement. We seek to extend this investigation to human cadaveric models by measuring and comparing esophageal and tracheal compliance curves.…”

Verification of endotracheal tube placement using electrical stimulation through electrodes placed on the endotracheal tube cuff

“…Clinical assessments of tube position including chest auscultation are unreliable . Thus, various methods for verifying endotracheal tube position have been developed . However, all the current methods can fail and be impractical, particularly in emergency settings such as cardiac arrest .…”