Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method

Abstract

Objective:To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method.Study Design:Prospective observational study.Place and Duration of Study:Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014).Methods:A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard.Results:In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013).Conclusion:The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested.

Measurement of Endotracheal Tube Cuff Pressure Using a Conventional Method in Elective Surgeries

“…[6] Many authors recommended routine instrumental monitoring. [3,5,7] In our study also the proportion of subjects achieving normal pressure with clinical method is very low, as in 9 out of 10 persons the cuff pressure was higher than recommended value.…”

“…Based on the available literature, it was observed that in 31% of the cases, a normal ETT cuff pressure was achieved. [3] At 95% level of significance and 10% absolute precision, the sample size was calculated as 82.13. Accounting 10% for non-response, the sample size was arrived at 90.3 and was finally rounded off to 100.…”

“…An optimum ETT cuff pressure ensures delivery of the mechanical ventilation tidal volume and simultaneously reducing the risk of aspiration without compromising the tracheal perforation. [3] the risk of aspiration of oropharyngeal contents, ventilator failure. [4] Therefore, a minimum pressure of 20 cm of H2O is recommended.…”

“…Despite the fact that its efficiency is intensely debated in recent times, the prevailing paucity of studies on this subject on Indian population is worth noting. [3] Objective 1. To estimate the mean ETT cuff pressures among the study participants.…”

Comparison of the endotracheal cuff inflation techniques and its postoperative laryngotracheal morbidity: an observational study

“…7 Despite the use of high-volume, low-pressure cuffs, certain patients remain at risk for cuff-induced laryngotracheal morbidity, even with short-duration anaesthesia. This has produced a growing interest in monitoring endotracheal tube cuff pressure intraoperatively and studying laryngotracheal morbidity as related to endotracheal cuff overinflation.…”