The effect of transoesophageal echocardiography probe insertion on tracheal cuff pressure

Abstract

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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“…Upper airway obstruction by a TEE probe [61] and average 8cm H 2 O increase in tracheal cuff pressure(so that cuff pressure exceeded 35cm H 2 O in 17 out of 38 patients) during routine TEE probe insertion [63] has also been reported. Indirect effects of TEE include haemodynamic changes and pulmonary effects of airway manoeuvring and distraction of new TEE operator from intraoperative patient care [57][58][59][60][61][62][63]. Atrial and ventricular arrhythmias due to direct cardiac irritation from the probe may occasionally occur.…”

“…Important limitations to TEE include the fact that certain regions of the heart and great vessels cannot be well visualized (most of these limitations may be overcome by more advanced technology, 3D echo and new imaging planes). The procedure is usually safe, but insertion and manipulation of the TEE probe can directly traumatize the airway and oesophagus, leading to orodental or laryngo pharyngeal trauma, oesophageal bleed, perforation, dysphagia, hoarseness and bacteraemia [57][58][59][60][61][62][63]. Upper airway obstruction by a TEE probe [61] and average 8cm H 2 O increase in tracheal cuff pressure(so that cuff pressure exceeded 35cm H 2 O in 17 out of 38 patients) during routine TEE probe insertion [63] has also been reported.…”

“…The procedure is usually safe, but insertion and manipulation of the TEE probe can directly traumatize the airway and oesophagus, leading to orodental or laryngo pharyngeal trauma, oesophageal bleed, perforation, dysphagia, hoarseness and bacteraemia [57][58][59][60][61][62][63]. Upper airway obstruction by a TEE probe [61] and average 8cm H 2 O increase in tracheal cuff pressure(so that cuff pressure exceeded 35cm H 2 O in 17 out of 38 patients) during routine TEE probe insertion [63] has also been reported. Indirect effects of TEE include haemodynamic changes and pulmonary effects of airway manoeuvring and distraction of new TEE operator from intraoperative patient care [57][58][59][60][61][62][63].…”

Comparison of Cuff Pressure Increases by Transesophageal Echocardiography: A Simulation Analysis Using a Porcine Pharyngeal Model

“…Tracheal cuff pressure increases during probe insertion for transesophageal echocardiography (TEE) more than is generally recommended and should be monitored carefully. 1 We compared TEE-mediated cuff pressure increases between a tracheal tube with a tapered cuff (Taper) or a conventional high-volume, low-pressure cuff (HVLP) using a porcine larynx model. 2 The porcine larynx model is isolated larynx including trachea and esophagus from 100 kg-to-120 kg edible male pigs.…”

Perioperative transoesophageal echocardiography: past, present & future

“…sore throat and odynophagia, are common and can be minimised by using a laryngoscope for placement [26–29]. A recent study by Tan et al demonstrates that there is a significant increase in tracheal cuff pressure after insertion of the TOE probe and recommends routine monitoring of cuff pressure after insertion [30]. The only absolute contraindication to a TOE in many clinicians’ eyes, ourselves included, is an oesophagectomy [10]!…”