Effect of various patient positions on endotracheal tube cuff pressure after adult cardiac surgery

Ziyaeifard, Mohsen; Ferasatkish, Rasoul; Alizadehasl, Azin; Faritous, Zahra; Alavi, Seyed Mostafa; Pouraliakbar, Hamidreza; Zare, Maryam; Dehdashtian, Ehsan

doi:10.4103/rcm.rcm_13_17

Cited by 3 publications

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“…Ihr Einsatz im Zuge der Intubation und initialen Justierung des Cuffdrucks wird aber immer gebräuchlicher, denn eine Messung des Drucks stellt den einzigen Schutz vor unkontrollierbar hohen Cuffdrücken dar [43]. Die kontinuierliche oder mehrfache Kontrolle des Cuffdrucks im Verlauf einer Anästhesie ist jedoch bei Patienten, die ein hohes Risiko für perioperative Veränderungen des Cuffdrucks haben, wie zum Beispiel Patienten, die häufig umgelagert werden oder eben jene, bei denen Lachgas verwendet wird, ebenfalls anzuraten [44,45].…”

Section: Statistikunclassified

Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas

Benesch,

Paul,

Alef

2023

Tierarztl Prax Ausg K Kleintiere Heimtiere

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Zusammenfassung Gegenstand und Ziel Die Verwendung eines Lachgas-/Sauerstoff-Gemischs bei einer Inhalationsanästhesie führt durch Diffusion von Lachgas in die Blockmanschette des Endotrachealtubus (Cuff) zu einem Anstieg des Drucks im Cuff, wenn dieser, wie üblich, mit Luft gefüllt wurde. Ziel der vorliegenden Studie war, die Entwicklung des Cuffdrucks während einer Isofluran-Lachgasanästhesie unter klinischen Bedingungen bei der Katze zu untersuchen und mögliche Einflussfaktoren wie Tubusgröße und Gesamtgasflussrate zu identifizieren. Tiere, Material und Methoden In der prospektiven Studie wurden Katzen eingeschlossen, die in der Klinik für Kleintiere der Universität Leipzig eine Inhalationsanästhesie mit Lachgas über mindestens 60 Minuten erhielten. Der Cuffdruck wurde mit einem Cuffdruckmanometer auf den minimal-okklusiven Druck eingestellt und sein Verlauf aufgezeichnet. Ergebnisse Insgesamt wurden Cuffdruckwerte von 24 Katzen aufgezeichnet, dabei wurde nach Tubusgröße (ID 4,0 mm und ID 4,5 mm) sowie nach Flussrate (niedrig 0,6 l/min und hoch 3 l/min) gruppiert. Es zeigte sich ein Anstieg des Cuffdrucks über die Zeit, ab dem Zeitpunkt 45 Minuten war dieser signifikant erhöht zum Ausgangswert (p=0,005). Nach 60 Minuten kam es zu einem mittleren Cuffdruckanstieg von 3 cmH2O. Die Druckverläufe variierten individuell sehr stark, so wurden Werte bis zu 48 cmH2O erreicht. Bei keiner Katze wurde das Abbruchkriterium von 60 cmH2O Druck im Cuff erreicht. Effekte der Tubusgröße (p=0,63) und der Flussrate (p=0,334) auf den Verlauf des Cuffdrucks konnten nicht nachgewiesen werden. Schlussfolgerung Nach 45 Minuten Lachgaszufuhr kommt es zu einem signifikanten Anstieg des Cuffdrucks bei der Katze. Die Tubusgröße und die Gesamtgasflussrate scheinen bei der Katze aber keinen Einfluss auf die Entwicklung des Cuffdrucks zu haben. Klinische Relevanz Bei Nutzung von Lachgas im Rahmen einer Inhalationsanästhesie muss bei der Katze auf eine regelmäßige Kontrolle und Korrektur des Cuffdrucks geachtet werden. Die individuellen Druckverläufe sind allerdings so variabel, dass keine feste Empfehlung für ein optimales Management gegeben werden kann.

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Section: Statistikunclassified

Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas

Benesch,

Paul,

Alef

2023

Tierarztl Prax Ausg K Kleintiere Heimtiere

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Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

Sousa

Kapp

Santamaria

2020

International Wound Journal

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The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side‐lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose‐designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose‐designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high‐risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z‐Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side‐lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°‐26°, the foam wedge 29°‐27°, and the pillow 23°‐21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°‐71°, a difference of 7°) and the pillow alone (79°‐74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°‐86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.

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Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study

Elzohry¹

2020

J Clin Anesthes Res

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Aim: This prospective comparative study aimed to investigate the effect of various body positions on changes of respiratory parameters mostly; the TV, oxygen saturation, airway pressure, and endotracheal tube cuff pressure in mechanically ventilated critical care patients. Background: Many patients who are admitted to the critical care unit require intubation and invasive mechanical ventilation for many reasons such as major trauma, medical causes, or post-operative major surgeries. Changing a patient’s position in the critical care unit is very important for the following benefits; to break through the routine monotonic delivery of mechanical ventilation, to favor the clearance of respiratory secretions, the prevention of pressure sores and ventilator acquired pneumonia, and finally the improvement in lung volume and oxygenation. Methods: A prospective, comparative study was carried out on 210 patients of both gender, aged between 21-70 years old admitted to ICU due to many reasons. After stabilization of patient condition and connection of monitors’ cables, supine position or semi setting position was chosen and this was documented in the patient’s chart. All patients were sedated to prevent them from breathing against the machine which causes the ETT cuff pressure and mean airway pressure to rise. Fentanyl sedation drug (Loading dose: 1–2 mic/kg/hour infused gradually. Maintenance dose: 1-4 mic/kg/hour) using continuous intravenous infusion typically in combination with Midazolam sedation (0.05-0.2 mg/kg/hour). The following parameters were recorded; tidal volume, mean airway pressure, PO2 /FIO2 , and ETT cuff pressure. Results: Our results show that about (58.1%) were male and (41.9%) were female. Concerning age, their mean was between (40.6 ± 8.9) years. Regarding diagnosis (50.5%) of patients were admitted with major trauma, (31.9%) due to medical causes, and (17.6%) admitted due to major chest and abdominal surgeries. The patient’s mean heart rate was (93.6 ± 7.5) b/m and the Mean Arterial Pressure was (67.7 ± 0.6)°C. Tables the Description, SOP2, Mean airway, and ETT cuff pressure of each body position in the study with the highest SPO2 98% and cuff pressure 19.2+41 in the prone position. The position checklist is illustrated in Table and Figure. The highest TV (520 ml) and PO2 /FIO2 ratio (410) were in prone poison and the lowest was in Lower Fowler position (460 ml and 320) respectively. Regarding outcome and ICU stay which were the best in both semi setting and prone position. Conclusion: Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The semi-sitting position (with thorax angulation=30° from the horizontal plane) is associated with improvement of PO2/FIO2 , oxygenation, and tidal volume, and the effects of prone position on respiratory mechanics are very beneficial and this reflected on patient outcome and short ICU length of stay.

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Effect of various patient positions on endotracheal tube cuff pressure after adult cardiac surgery

Cited by 3 publications

References 1 publication

Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas

Inhalationsanästhesie bei der Katze: Die Entwicklung des Cuffdrucks bei Verwendung von Lachgas

Positioning immobile critically ill patients who are at risk of pressure injuries using a purpose‐designed positioning device and usual care equipment: An observational feasibility study

Airway Pressure and Respiratory Mechanics Variability with Different Body Positions in Mechanically Ventilated Critical Care Patients: A Prospective Comparative Clinical Study

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