Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in‐vitro assessment

Aeppli, Norbert; Lindauer, Bastian; Steurer, Marc P.; Weiß, Markus; Dullenkopf, Alexander

doi:10.1111/aas.13249

Cited by 28 publications

(29 citation statements)

References 32 publications

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“…Furthermore, there was an expression of concern for the cause of leaks by one respondent, which has been demonstrated in the literature. 27,28 For example, cuff pressure drops can be experienced from the initial connection or disconnection of the manometer to the pilot balloon and less frequently by the pressure gauge of the manometer. 27 However, correct use of cuff manometers with three-way valves or the use of continuous monitoring techniques have been described to avoid this complication.…”

Section: Discussionmentioning

confidence: 99%

“…27,28 For example, cuff pressure drops can be experienced from the initial connection or disconnection of the manometer to the pilot balloon and less frequently by the pressure gauge of the manometer. 27 However, correct use of cuff manometers with three-way valves or the use of continuous monitoring techniques have been described to avoid this complication. 29,30 Access to and the routine use of cuff manometers in Australian and New Zealand institutions is not mandatory.…”

Section: Discussionmentioning

confidence: 99%

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Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres

Lee

Reynolds

Pelecanos

et al. 2019

Anaesth Intensive Care

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Correct intracuff pressure of endotracheal tubes and supraglottic airway devices is required to avoid complications such as sore throat, dysphagia and dysphonia, while maintaining an adequate airway seal. However, intracuff pressure monitoring of airway devices during general anaesthesia may not receive the attention it deserves. The aim of this survey was to investigate the current practice regarding intraoperative cuff pressure monitoring in hospitals across Australia and New Zealand. An online ten-question survey was disseminated by the Australian and New Zealand College of Anaesthetists Clinical Trials Network to a randomised selection of 1000 Australian and New Zealand College of Anaesthetists Fellows working in private and public hospitals of varying sizes. There were 305 respondents in total, but not all respondents answered all questions. In total, 67 of 304 respondents (22.0%) did not have access to a cuff pressure manometer at their main site of work, and of these, 30 (9.9%) expressed that they would like access to one in their daily practice. Of 288 respondents, 122 (40.0%) reported that they used cuff pressure monitoring as part of their routine practice, but 95 (33.0%) measured the cuff pressure at induction only. For supraglottic airway devices, only 44 of 250 respondents (17.6%) aimed for a cuff pressure of 40–60 cmH2O. Of 255 respondents, 101 (39.6%) aimed for a cuff pressure of 20–30 cmH2O for endotracheal tubes. These findings indicate that educational programmes are required to increase the availability and use of cuff pressure monitoring devices for both endotracheal tubes and supraglottic airway devices across Australia and New Zealand.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres

Lee

Reynolds

Pelecanos

et al. 2019

Anaesth Intensive Care

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“…Fourth, in patients with automated P cuff adjustment but not in patients from routine care group, we used a three-way stopcock. Of note, direct connection of the manometer to the endotracheal tube may be source of air leakage [27]. The use of the three-way stopcock may have limited the air leakage by connecting the manometer before opening the dedicated outlet.…”

Section: Discussionmentioning

confidence: 99%

Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomized controlled study

Dauvergne

Geffray

Asehnoune

et al. 2020

Preprint

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Background Endotracheal tube cuff underinflation contributes to microaspiration of contaminated oropharyngeal content, source of pneumonia. Overinflation exposes to airway damage. Intermittent manual adjustment of the cuff pressure (P cuff ) may delay the detection of under- or overinflation. Devices for automated continuous adjustment of P cuff are promising but some are inconvenient, expensive or even harmful. This prospective randomized controlled study tested whether the Tracoe Smart Cuff Manager TM reduced the rate of patients undergoing ≥1 episode of underinflation (P cuff <20 cmH 2 O), as compared with routine manual P cuff adjustment. Secondary endpoints included comparisons of the rate of patients with ≥1 overinflation episode (P cuff >30 cmH 2 O), of the incidence of under- and overinflation episodes and of their magnitude. Methods Patients likely to receive invasive mechanical ventilation for >48 hours because of acute brain injury were randomly allocated to receive, during 48 hours, automated P cuff adjustment (combined with manual adjustment) or manual adjustment alone. In each group, P cuff was measured with a dedicated manual manometer, at least every 8 hours. Results Sixty patients were analyzed (28 patients with automated and 32 with manual P cuff adjustment) for 506 measurements of P cuff (237 and 269, respectively). As compared with manual adjustment, automated adjustment of P cuff was associated with 1) a lower rate of patients with ≥1 episode of underinflation (63% and 18%, respectively, p<0.001), 2) a lower incidence of underinflation episodes (15% vs. 2%;p<0.001), 3) a lower rate of manual adjustments (77% vs. 56%;p<0.001) and 4) manual adjustments of lower magnitude (5.9±4.5 vs. 3.6±4.7 cmH 2 O;p<0.001). For overinflation, there was no significant between-groups differences (p>0.99). Conclusions The adjunction of a continuous P cuff control with the Tracoe Smart Cuff Manager TM to routine manual intermittent adjustment reduced both the incidence of P cuff underinflation episodes and their magnitude without provoking overinflation.

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“…However, our previous study, as well as, other sever studies has demonstrated that this unreliable technique puts patients at the risk of unnecessary high intra-cuff pressure with subsequent laryngotracheal complication. [19][20][21][22][23]…”

Section: Regulation Of Ett Cuff Pressure 41 Estimation Of Cuff Pressure By Pilot Balloon Palpationmentioning

confidence: 99%

Endotracheal tube cuff pressure: An overlooked risk

Fallatah

Al-Metwalli

Alghamdi

2021

Anaesth. pain intensive care

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The endotracheal tube (ETT) cuff's principal function is to implement proper tracheal sealing at a pressure high enough to prevent both gas leak and fluid aspiration, and low enough to maintain tracheal perfusion. Clinicians are often concerned primarily with the volume of air required to inflate an ETT cuff. However, the most important factor is how much pressure will be exerted on the tracheal mucosa when the cuff is properly distended. Cuff over-inflation complications range from sore throat to tracheal ischemia with tracheal rupture and fistula formation. The ideal ETT cuff pressure has not been defined with a high degree of certainty however most anesthesiologists generally recommend a target pressure of 20 to 30 cmH2O. Although trachea-gas sealing can be achieved at ETT cuff pressure of 20 cmH2O, microaspiration can occur at a cuff pressure of 60 cmH2O. Since the introduction of cuffed ETT in the mid- 20th century, several modifications in the cuff's shape and material have been done to address these challenges. It has been proven that the pressure within the inflated cuff is a dynamic process. As such, various clinical factors will significantly impact the pressure reading. Thus, continuous regulation of ETT cuff pressure should be routine practice. Our review included 158 articles that addressed the background into the development of cuffed ETT, function and anatomy of the ETT cuff system, cuff pressure and sealing characteristics, ETT cuff pressure regulation, microaspiration, and factors affecting ETT cuff pressure. Key words: Endotracheal Tube; Cuff pressure; Microaspiration Citation: Al-metwalli RR, Fallatah SM, Alghamdi TM. Endotracheal tube cuff pressure: An overlooked risk. Anaesth. pain intensive care 2021;25(1):86–95; DOI: 10.35975/apic.v25i1.1445 Received: 2 November 2020, Reviewed: 24 December 2020, Accepted: 1 January 2021

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Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in‐vitro assessment

Abstract: Routine manual cuff pressure control manoeuvres in ETT cuffs result in considerable cuff pressure drops. This may have an impact on silent aspiration of pharyngeal contents passing along the cuff into the lower airway.

Cited by 28 publications

References 32 publications

Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres

Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres

Automatic regulation of the endotracheal tube cuff pressure with a portable elastomeric device. A randomized controlled study

Endotracheal tube cuff pressure: An overlooked risk

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