Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial

Abstract

BACKGROUND The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change. AIM To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation. METHODS In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH 2 O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH 2 O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured. RESULTS The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH 2 O) than in the cylindrical cuff (25.5 ± 0.8 cmH 2 O) after head and neck extension ( P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) ( P < 0.001). The incidence of postoperative airway complications was comparable between two groups. CONCLUSION After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.

Complications of orotracheal intubation in the horse

“…Changes in neck position will change the cuff pressure. This effect was greater in tapered cuffs as compared to cylindrical shaped cuffs (J. H. Park et al, 2021;Seol et al, 2022). It is interesting to speculate what would have been the effect of neck flexion on the "tight' fit of the endotracheal tube in this clinical case since theoretically this should lead to longitudinal shortening of the tracheal and a slight increase in diameter of the tracheal.…”

“…This effect could contribute to the formation of tracheal oedema thus increasing the tracheal-cuff interface pressure. Another effect of body position is the degree of neck flexion and how it impacts endotracheal cuff pressures (J. H. Park, Lee, Lee, & Kim, 2021; S. Park, Kwon, & Kim, 2023;Seol, Jin, Oh, Byun, & Jeon, 2022). Changes in neck position will change the cuff pressure.…”

Complications of orotracheal intubation in the horse

“…Changes in neck position will change the cuff pressure. This effect was greater in tapered cuffs as compared to cylindrical shaped cuffs (Park et al., 2021; Seol et al., 2022). It is interesting to speculate what would have been the effect of neck flexion on the ‘tight’ fit of the endotracheal tube in this clinical case since theoretically this should lead to longitudinal shortening of the tracheal and a slight increase in diameter of the tracheal.…”

“…This effect could contribute to the formation of tracheal oedema, thus increasing the tracheal-cuff interface pressure. Another effect of body position is the degree of neck flexion and how it impacts endotracheal cuff pressures (Park et al, 2021(Park et al, , 2023Seol et al, 2022). Changes in neck position will change the cuff pressure.…”