Evaluation of Endotracheal Tube Cuff Pressure and the Use of Three Cuff Inflation Syringe Devices in Dogs

Abstract

Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal mucosal irritation, tracheal wall ischemia or necrosis, whereas under-inflation increases the risk of pulmonary aspiration as well as leaking anesthetic gas and polluting the environment. The objectives of this two-phase study were to (1) identify the incidence of improper ETT cuff inflation (both over-and under-inflation) using the minimum occlusive volume (MOV) technique coupled with a regular injectable syringe in the anesthetized dogs, and (2) evaluate the performance of two commercially available inflation syringe devices (Tru-Cuff and AG Cuffill ®) with the regular injectable syringe in inflating the ETT cuff to a recommended safe cuff pressure range (20-30 cmH 2 O). Dogs undergoing general anesthesia at Purdue Veterinary Medicine Teaching Hospital were included. The ETT cuff pressure was assessed with an aneroid manometer after the syringe inflation. The results of the first objective showed that a total of 80 dogs enrolled and that 50 of these 80 dogs required ETT cuff inflation. Among the 50 dogs, only 14% had proper ETT cuff inflation; 76% of the ETT cuffs were over-inflated and 10% were under-inflated. Ninety dogs were enrolled for the second objective study and they were randomly and equally assigned to the three syringe device treatment groups. The results showed that 80% of the ETT cuffs were over-inflated in the regular injectable syringe treatment group, whereas only 6.7% and 3.3% ETT cuffs were over-inflated in the Tru-Cuff and AG Cuffill ® syringe treatment groups, respectively. The AG Cuffill ® syringe treatment group had a significantly (p < 0.05) higher percentage of properly inflated ETT cuffs (86.7%) compared to the other two groups (regular injectable syringe [3.3%]; Tru-Cuff syringe [50%]. We concluded that there was a high incidence of improper ETT cuff inflation when using MOV technique coupled with a regular injectable syringe. The use of an AG Cuffill ® syringe significantly reduced improper ETT cuff inflation.

Methods Used for Endotracheal Tube Cuff Inflation and Pressure Verification in Veterinary Medicine: A Questionnaire on Current Practice

“…This result is not in line with evidence obtained in humans [ 27 , 28 , 29 ], as well as in dogs and cats [ 1 , 2 , 30 , 31 ] establishing the inferiority of MOV to the use of a manometer in achieving a pre-specified (i.e., target) cuff pressure. Furthermore, when comparing MOV in cats and dogs to the use of commercially available syringe inflation devices, MOV proved inferior [ 2 , 32 ]. Whereas these studies clearly concluded that a cuff manometer should be used to achieve optimal ETT cuff pressure, the use of MOV was three times more common than cuff pressure measurement in dogs and cats in the current study.…”

Paralisia de laringe unilateral esquerda pós intubação em braquicefálico: Relato de caso

“…A inserção do traqueotubo de forma ríspida pode lesionar o músculo cricoaritenoideo, as articulações cricotireoideas e por consequência comprometer a função laríngea (Brown, 2007;Camargo et al, 2022). Uma hiperinsuflação do cuff pode levar a isquemia e lesão do nervo laríngeo recorrente, estudos indicam limite máximo de pressão do cuff variando entre 18 mmHg e 24 mmHg monitorados através de uma seringa medidora de pressão que é a técnica mais eficiente para controlar a pressão de insuflação e evitar lesões (Briganti et al, 2012;Castilho et al, 2003;Hung et al, 2020). No presente caso não foi utilizado um método de avaliação da pressão utilizada para insuflar o cuff, o que pode ter favorecido uma pressão excessiva e uma possível lesão nervosa através da compressão e comprometimento da microcirculação nervosa como já descrito em outros estudos (Camargo et al, 2022;Daly et al, 2022;Evman & Selcuk, 2020;Rodriguez et al, 2020).…”

Bilateral laryngeal paralysis following a ventral slot surgery in a dog

“…Overinflation of an ETT cuff may also lead to tracheal ischaemia and necrosis. Therefore, the most efficient technique in controlling the inflation pressure and to avoid these lesions is by using an accurate cuff pressure control syringe 22…”