Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.

Seegobin, R.D.; Hasselt, G. L. Van

doi:10.1136/bmj.288.6422.965

Cited by 535 publications

(412 citation statements)

References 10 publications

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“…2,26 Moreover, one case in group T showed a cuff pressure of 60 cm H 2 O, an amount that is known to block the circulation of the trachea completely. 4 Tracheal mucosal blood flow can be influenced by various factors such as perfusion pressure and vasomotor status. To prevent a decrease in tracheal mucosal blood flow, intraoperative blood pressure should be cautiously monitored, because intraoperative hypotension can impair tracheal mucosal blood flow by reducing perfusion pressure.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] A cuff pressure of more than 30 cm H 2 O is known to cause obstruction to mucosal blood flow in the trachea. 4 Partial denuding of the basement membrane was found at an ETT cuff pressure over 50 cm H 2 O. 4 An increase in the ETT cuff pressure is associated with increased postoperative complications such as postoperative sore throat and hoarseness.…”

Section: Résumémentioning

confidence: 99%

“…4 Partial denuding of the basement membrane was found at an ETT cuff pressure over 50 cm H 2 O. 4 An increase in the ETT cuff pressure is associated with increased postoperative complications such as postoperative sore throat and hoarseness. 2,5,6 The intracuff pressure can be affected by various factors, including environmental factors (e.g., intraoperative use of high airway pressure and nitrous oxide), patient factors (e.g., differences in the size of the trachea and the position of the intratracheal cuff), and cuffrelated factors (e.g., differences in cuff compliance and diameter).…”

Section: Résumémentioning

confidence: 99%

See 2 more Smart Citations

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

Kim

Lee

Kim

et al. 2015

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

Kim

Lee

Kim

et al. 2015

Can J Anesth/J Can Anesth

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“…An infl ating cuff pressure less than 20 cmH 2 O may favor secretion drainage, while a pressure greater than 30 cmH 2 O may result in mucosal injury [18]. Despite routine cuff pressure controls, variations in ETT cuff pressure frequently occur, exposing patients to increased risk of VAP [19].…”

Section: Cuff Carementioning

confidence: 99%

Novel Preventive Strategies for Ventilator-associated Pneumonia

Coppadoro¹,

Bittner²

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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Ventilator-associated pneumonia (VAP) is a complication of mechanical ventilation and is defi ned as the occurrence of pneumonia in patients undergoing mechanical ventilation for at least 48 hours. Clinical suspicion of VAP arises when new infi ltrates are present on chest x-ray, and at least one of the following is present: Fever, leukocytosis, or purulent tracheo-bronchial secretions.Th e incidence of VAP reported in the literature ranges from 15 to 20% [1]. However, the real incidence of VAP is diffi cult to assess, given the extreme variability of the diagnostic criteria for pneumonia, which often rely on broncho scopic procedures. Th e specifi c mortality attribu table to VAP is also debated. Th e reported VAPassociated mortality ranges from 20 to 70%. Patients with VAP are often critically ill, and survival may be aff ected both by underlying conditions and the new-onset VAP. A recent study demonstrated a relatively limited attributable intensive care unit (ICU)-mortality of VAP, about 1-1.5%, when adjusting for severity of co-existing diseases [2]. In the last few years, various strategies have been investigated in order to reduce the incidence of VAP. Reducing the duration of intubation, oral and endotracheal tube (ETT) care, positioning, and ETT modifi cations are aspects that may have a role in the prevention of VAP. Many of these strategies have been incorporated into 'VAP bundles' , a set of treatments implemented simultaneously to reduce VAP incidence. Recent studies suggest that the use of bundle treatments can result in substantial reductions in rates of VAP [3].In this chapter, we will present some novel VAP prevention strategies, explaining the possible mechanisms by which they may be clinically benefi cial in reducing the incidence of VAP. A summary of these novel strategies is given in Table 1. Reduce duration of intubationTh e risk of developing VAP increases with prolonged intu bation, and reintubation is a known risk factor [4]. Th is fact suggests that the presence of the ETT, although necessary for the survival of the patient, interferes with the normal physiological mechanisms that maintain the airways free of bacterial contamination. When the ETT is in place, the cough refl ex is impaired and normal mucociliary fl ow is blocked by the infl ated cuff . Th e ETT itself allows bacteria to drain into the trachea and distal airways leading to pneumonia. Intubated patients may be more prone to develop VAP as compared to tracheostomized patients because the ETT keeps the trachea and the oropharynx in communication, acting as a bridge for bacteria to move toward the dependent airways. Aspiration of pathogens from the oropharynx in patients with subglottic dysfunction may occur both during extubation and reintubation. Th e rate of reintubation can be reduced by a variety of measures, including avoiding accidental removal of the ETT, improving planned extubations with weaning protocols designed to improve extubation success, and use of non-invasive ventilation (NIV).On the basis of the observatio...

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“…The valve of the pilot balloon of the bronchial cuff was connected to an aneroid manometer (Mallinckrodt Medical, Athlone, Ireland) via a threeway stopcock followed by inflation of the bronchial cuff with air at a pressure of 35 cm H 2 O which is sufficient to seal the bronchus, 3 and around which bronchial mucosal damage can be minimized. [4][5][6] The volume of air injected into the cuff at this position was recorded. Two-lung ventilation was changed to right-sided, onelung ventilation with the minute volume of 0.1 L·kg -1 at a rate of 20 bpm.…”

Section: Methodsmentioning

confidence: 99%

Bronchial cuff pressure change caused by left-sided double-lumen endobronchial tube displacement

Araki

Nomura

Urushibara

et al. 2000

Can J Anesth/J Can Anesth

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REPORTS OF INVESTIGATION 775CAN J ANESTH 2000 / 47: 8 / pp [775][776][777][778][779] Purpose: The bronchial cuff pressures (BCPs) of left-sided double-lumen endobronchial tubes (DLTs) manufactured by Rüsch and Mallinckrodt were measured in 80 patients when the tubes were withdrawn to compare the effect of tube design on BCP change.Methods: During general anesthesia with muscle relaxation, the cephalad surface of the endobronchial cuff was positioned either 2.5 cm distal to the carina (Rüsch Group R-I; n = 20 and Mallinckrodt Group B-I; n = 20) or just below the carina (Rüsch Group R-II; n = 20 and Mallinckrodt Group B-II; n = 20) and the cuff was inflated to 35 cm H 2 O. The tube was then withdrawn in 0.5-cm steps until the cuff was 2.0 cm proximal to the carina, the position just before the capnogram or pressure-volume loop of tracheal lumen changed. The BCP at each step was measured. The rate of decrease in BCP was defined as the decrease of BCP divided by the length of displacement of DLT. Results:The rates of decrease from the +2.5 cm position to the end point in Group B-I (7.7 ± 0.8 cm H 2 O·cm -1 ) and those from the most proximal acceptable position to the end point in Group B-II (19.5 ± 4.8 cm H 2 O·cm -1 ) were greater than those in Group R-I (6.9 ± 0.9 cm H 2 O·cm -1 ) (P < 0.01) and in Group R-II (12.4 ± 3.1 cm H 2 O·cm -1 ) (P < 0.01), respectively. Conclusion:The BCP decreased in both of the Mallinckrodt and Rüsch DLTs, and the rates of decrease of the former were greater than those of the latter.Objectif : Les pressions du ballonnet bronchique (PBB) des tubes à double lumière (TDL) gauches fabriqués par Rüsch et Mallinckrodt ont été mesurées chez 80 patients au moment du retrait des tubes afin de comparer l'effet du design du tube sur le changement de PBB.

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Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.

Cited by 535 publications

References 10 publications

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

Novel Preventive Strategies for Ventilator-associated Pneumonia

Bronchial cuff pressure change caused by left-sided double-lumen endobronchial tube displacement

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