Influence of temperature on tracheal tube cuff pressure during cardiac surgery

Neto, E. P. Souza; Piriou, Vincent; Durand, P.G.; George, Merit P; Evans, R. J.; Jf, Obadia; Lehot, J.-J.

doi:10.1034/j.1399-6576.1999.430315.x

Cited by 19 publications

(13 citation statements)

References 13 publications

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“…We found 31% and 28% of patients' cuffs over-pressured, as measured by investigators and nurses respectively. ICU patients' physical condition, position, ventilatory parameters and nursing care requirements are constantly changing, and these variables have been shown to affect cuff manometry [16][17][18] . We postulated that patients with less compliant respiratory mechanics, as evidenced by higher peak inspiratory pressures during mechanical ventilation, may require higher cuff pressures to achieve a seal around the ETT.…”

Section: Discussionmentioning

confidence: 99%

The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

Harvie

Darvall

Dodd

et al. 2016

Anaesth Intensive Care

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Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under-and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20-30 cmH 2 O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a threemonth period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH 2 O; 11 of 45 patients (24%) had cuff pressures <20 cmH 2 O; 14 of 45 patients (31%) had cuff pressures ≥30 cmH 2 O. Univariate analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume (P=0.008 and P <0.001 respectively), though this association was lost on multivariate analysis. No association was demonstrated between any measured variables and cuff pressures. Interoperator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over-and under-inflation, and alternative techniques, such as cuff manometry, should be employed.

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Section: Discussionmentioning

confidence: 99%

The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

Harvie

Darvall

Dodd

et al. 2016

Anaesth Intensive Care

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show abstract

“…Inada et al. found that cuff pressure was significantly reduced (from a mean baseline value of 20 to 8 mmHg) during hypothermic cardiopulmonary bypass [21]; however, this was not observed in patients receiving normothermic cardiopulmonary bypass [22]. They explained that the changes observed during hypothermia might be attributed to cold‐induced vasoconstriction and shrinkage of the microvasculature of the tracheal wall to widen the tracheal calibre.…”

Section: Discussionmentioning

confidence: 99%

The effect of transoesophageal echocardiography probe insertion on tracheal cuff pressure

Tan¹,

Lin²,

Chen³

et al. 2011

Anaesthesia

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SummaryIncreased tracheal cuff pressure during mechanical ventilation is associated with reduced mucosal blood flow and ischaemia, as well as postoperative sore throat. We assessed the potential effects of transoesophageal echocardiography probe insertion on the tracheal cuff pressure in patients undergoing cardiac surgery. Using a manometer, the cuff pressure of a high-volume, low-pressure tracheal tube (inner diameter 7.0 mm for women and 7.5 mm for men) was adjusted to 25-30 cmH 2 O before blind insertion of a transoesophageal echocardiography probe. The pressure changes were then recorded for 1 min. After probe insertion, the mean (SD) intra-cuff pressure increased from 27.7 (1.5) to 36.2 (6.4) cmH 2 O (p < 0.001) and was > 35 cmH 2 0 in 17 ⁄ 38 patients (45%). Our results suggest that transoesophageal echocardiography probe insertion may increase the tracheal cuff pressure more than that is generally recommended and therefore the latter should be routinely monitored under such circumstances.

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“…As shown in figure 2, the system exhibited a fast response under challenging conditions that would represent extreme changes in Pcuff in the clinical setting. The changes in cuff compression imposed in the bench study covered the ones that can reasonably be found in patients as a result of displacement of the endotracheal tube, a change in the tracheal wall tone, diffusion of anaesthetic gases [15] or hypothermic surgical procedures [16]. In particular, the fast response time of the devised procedure ensures its efficacy in compensating for leaks in the cuff, which usually have time constants much longer than the response time of the system.…”

Section: Discussionmentioning

confidence: 99%

Automatic regulation of the cuff pressure in endotracheally-intubated patients

Farré¹,

Rotger²,

Ferrer³

et al. 2002

Eur Respir J

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To avoid tracheal wall damage or inadvertent falls of the endotracheal tube cuff pressure (Pcuff) in intubated and mechanically-ventilated patients, the authors devised a simple procedure for automatic and continuous regulation ofPcuff.The procedure, only requiring a simple aquarium air pump and conventional tubing, was first tested at the bench when applied to an intubated and ventilated lung model, including an artificial trachea with an externally-variable section. The clinical performance of the procedure was tested in eight intubated patients, in whom the endotracheal tube cuff was connected to the designedPcuffregulator during 24 h.The bench test showed that the procedure was able to maintainPcuffconstant, regardless of the changes imposed in the tracheal section. It was also effective in maintainingPcuffduring routine mechanical ventilation. ActualPcuffrecorded over the 24-h period always coincided with the target value within ±2 cmH2O in all the patients.The procedure devised to maintain endotracheal tube cuff pressure is readily implemented, cheap, easy to operate and can be used regardless of the specific ventilator or tube used. Routine implementation of this procedure may be useful for protecting the trachea from tissue damage and for reducing the risk of ventilator-associated pneumonia.

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Influence of temperature on tracheal tube cuff pressure during cardiac surgery

Abstract: We conclude that the ITCP is higher in normothermic CPB than in hypothermic CPB; however, the clinical significance of this observation needs further investigation.

Cited by 19 publications

References 13 publications

The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

The effect of transoesophageal echocardiography probe insertion on tracheal cuff pressure

Automatic regulation of the cuff pressure in endotracheally-intubated patients

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