Does the endotracheal tube cuff pressure increases with transesophageal probe insertion?

Abstract

Context: The cuff pressure (CP) of the endotracheal tube (ETT) exceeding 30 cm of H 2 O results in reduced perfusion of lateral mucosa of trachea leading to complications. As the posterior tracheal wall is in contact with the esophagus, there is a possibility that the insertion of transesophageal echo (TEE) probe may compress the tracheal wall and increase CP. Aims: This study was aimed to assess the impact of TEE probe insertion on CP in adults undergoing cardiac surgery. Settings and Design: Prospective observational study of 65 patients at tertiary care level hospital. Subjects and Methods: After balanced general anesthesia, patients were intubated with high volume low-pressure ET.TEE probe was then inserted with gentle jaw thrust. CP was measured by standard invasive pressure monitoring device at four points: T1 at baseline before TEE probe insertion; T2 maximum CP noted at TEE probe insertion; T3 at 5 min post TEE probe insertion; and T4 at post-TEE exam. Statistical Analysis Used: CP was compared between pairs of time points (T1 vs. T2; T1 vs. T3; and T1 vs. T4) using Mann-Whitney U test. Factors predicting CP >30 cm of H 2 O at T4 were assessed by backward stepwise regression. Results: CP (mean ± S.D.) at T1, T2, T3, and T4 was 22 ± 3, 38 ± 10, 30 ± 6, and 30 ± 7, respectively. CP increased significantly from T1 to T2 ( P < 0.001), T1 to T3 ( P < 0.001), and T1 to T4 ( P < 0.001). There were 26 patients (40%) with CP >30 cm of H 2 O at end of TEE exam (T4). On multivariate analysis baseline, CP (T1) >20 cm of H 2 O was significantly associated with CP >30 cm of H 2 O at end of TEE exam with Odd's Ratio (OR) of 8.5 (1.76–41.06, P = 0.008). Conclusions: To conclude, the CP increases significantly with TEE probe insertion in 40% of patients exceeding a safe limit of 30 cm of H 2 O. The monitoring and optimization of CP is advisable.

The Effect of Transesophageal Echocardiography Probe Insertion in Endotracheal Tube Cuff Pressure in Adult Cardiac Surgical Patients.

“…3,4 Various studies has shown that in different periods of TEE insertion and examination, the cuff pressure has increased. In a study done by Borde DP et al 9 The mean cuff pressure increased form baseline 22±3 to 38±10 cm of H 2 O after insertion of probe and to 30±6 cm of H 2 O after TEE examination which were statistically significant. Similar study done by Tan PH et al 7 also found similar results in consistent to our study where mean cuff pressure increased from 27.7±1.5 to 36.2±6.4 cm of H 2 O after TEE probe insertion and 45% (17/38) of patients had a cuff pressure of more than 35 cm of H 2 O.…”

“…Total 36 patients were taken as our sample size for the study to have 95% confidence interval and power of 90% from previous study done by Borde DP et al 9 After the patient was brought to the operation theatre, standard monitoring such as electrocardiography and pulse oximetry were applied. Invasive blood pressure monitoring line and central venous catheter through right internal jugular vein were inserted under standard aseptic precautions.…”

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

“…The number of patients in the included studies ranged from 13 to 80. Of the ten studies, seven reported on adult patients 24 , 26 , 27 , 30 , 40 – 42 , two focused on the pediatric population 25 , 28 , and one included both adult and pediatric patients 31 . The median or mean age of patients was between 0.5 and 66.8 years with a male prevalence of 28.3%-86.4%.…”

“…Nine studies provided the BMI of the participants that ranged from 15.3 to 44.5 kg/m 2 , while this information was unavailable in the other study 25 . Seven studies involved cardiac surgery 24 , 26 , 28 , 31 , 40 – 42 , two investigated bariatric surgery 27 , 30 , and the other was on esophagogastroduodenoscopy 25 . One study, which examined the change in cuff pressure among patients undergoing endotracheal intubation with single and double lumen ETTs 29 , was split into two (i.e., Kim 2015a, Kim 2015b) to differentiate the study outcomes between the two devices.…”

“…Seven studies were available for the analysis 24 , 26 – 28 , 31 , 41 , 42 . A forest plot revealed a high risk of high cuff pressure following EDI (RR = 12.82, 95% CI 4.9 to 33.52, p < 0.00001; I 2 = 47%) (Fig.…”