The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator

White, Donna M.; Redondo, J. I.; Mair, Alastair; Martínez-Taboada, Fernando

doi:10.1016/j.vaa.2016.11.006

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…White et al also reported a tendency to underinflate for P, with the use of the same simulator. 25 P is consistently reported to be an inaccurate cuff inflation technique, with overinflation frequently reported in both simulator-based and in vivo human and veterinary models. 15,17,21,30,31 Pisano et al postulated that P is frequently reported to be an inaccurate technique because the smaller radius of the pilot balloon creates a lower wall tension (Law of Laplace) when compared with the larger endotracheal cuff; therefore, predisposing to overinflation.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports of MOV with the use of an FAS showed experienced clinicians had a tendency towards overinflation while students had a tendency towards underinflation. 25 Only experienced clinicians were included in the current study and this might explain the result obtained. Bird et al also used MOV for cuff inflation in their feline clinical study and reported significant cuff overinflation with pressures of 56 ± 28 cmH 2 O and 66 ± 25 cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

“…The use of simulators is becoming increasingly common in many disciplines of human and veterinary medical training. The use of simulators for ETC inflation testing and training has been reported previously in human 23,24 and veterinary 25 literature. Basic tracheal simulators can be easy to construct, allowing clinicians to develop the skills required for appropriate cuff inflation, without the use of live animals.…”

Section: Introductionmentioning

confidence: 86%

“…The FAS was built as previously described. 25 The FAS was intubated with a 4.5 mm ETT (Microcuff Paediatric Endotracheal Tube 4.5 mm; Halyard), connected to a paediatric circle breathing system (SW Low Volume Breathing Circuit; Darvall) with a 1 l reservoir bag connected to an anaesthetic machine with internal ventilator (GE Datex-Ohmeda Aespire 7900; GE Healthcare). The ETT pilot balloon was directly connected to a manometer (Cuff Pressure Monitor, NS 60-TBS-CP; Instrumentation Industries), allowing the measurement of intracuff pressure after its inflation.…”

Section: Methodsmentioning

confidence: 99%

“…A sample size calculation was performed using the results obtained in a previous study. 25 A sample of 40 observations was considered adequate to detect a difference of 30% in the proportion of participants successfully reaching 20-30 cmH 2 O with one of the techniques, using a power of 80% and 95% level of significance. The data were analysed for normality with the Shapiro-Wilk test.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator

White

Makara

Martínez-Taboada

2019

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to compare four inflation techniques on endotracheal tube cuff (ETC) pressure using a feline airway simulator. Methods Ten participants used four different endotracheal cuff inflation techniques to inflate the cuff of a low-pressure, high-volume endotracheal tube within a feline airway simulator. The simulator replicated an average-sized feline trachea, intubated with a 4.5 mm endotracheal tube, connected to a circle breathing system and pressure-controlled ventilation with oxygen and medical air. Participants inflated the ETC: by pilot balloon palpation (P); by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during mechanical ventilation; until a passive release of pressure with use of a loss-of-resistance syringe (LOR); and with use of a syringe with a digital pressure reader (D) specifically designed for endotracheal cuff inflation. Intracuff pressure was measured by a manometer obscured to participants. The ideal pressure was considered to be between 20 and 30 cmH2O. Data were analysed by Shapiro–Wilk, Kruskal–Wallis and χ2 tests, as appropriate. Results Participants were eight veterinarians and two veterinary nurses with additional training in anaesthesia. Measured median intracuff pressures for P, MOV, LOR and D, respectively, were 25 cmH2O (range 4–74 cmH2O), 41 cmH2O (range 4–70 cmH2O), 31 cmH2O (range 18–64 cmH2O) and 22 cmH2O (range 20–30 cmH2O). D performed significantly better ( P <0.001) than all other techniques, with no difference between the other techniques. Conclusions and relevance Use of D for cuff inflation achieved optimal cuff pressures. There may be high operator-dependent variability in the cuff pressures achieved with the use of P, MOV or LOR inflation techniques. As such, a cuff manometer is recommended when using any of these techniques.

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