The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

Harvie, D A; Darvall, Jai; Dodd, M; Cruz, Augusto; Tacey, Mark; D’Costa, Rohit; Ward, David J.

doi:10.1177/0310057x1604400512

Cited by 16 publications

(19 citation statements)

References 18 publications

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“…They showed that MLT causes both over- and under-inflation of the ETT cuff, and other techniques like cuff manometry should be employed. 19 Carhart et al in their study purposed to define the optimal cuff inflation volume to achieve the 20-30 cmH2o cuff pressure. They showed that the cuff inflation volume range of 6-7 mL resulted in the highest likelihood of achieving the desired cuff pressure range, while cuffs inflated with 8-10 mL resulted in dangerously high cuff pressures in all instances.…”

Section: Introductionmentioning

confidence: 99%

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Sanaie

Rahmani

Chokhachian

et al. 2019

J Cardiovasc Thorac Res

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Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46.07±23.54 cmH2O in the fixed volume group and 33.72±9.14 cmH2O in the MLT group (P=0.05) which is significantly higher in the fixed volume group (P=0.028). In addition, 56.4% and 78.2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P=0.025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.

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Section: Introductionmentioning

confidence: 99%

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Sanaie

Rahmani

Chokhachian

et al. 2019

J Cardiovasc Thorac Res

View full text Add to dashboard Cite

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“…Underinflation rates in our study (45%) were similar to those reported by Valencia et al [19] (45.3%; n = 33) after evaluating CP in adult ventilated subjects in semi-recumbent position in the adult ICU. Harvie et al [12] (24% underinflation rate) also measured using the MLT in mechanically ventilated adults in in the supine position at 30-degree head up. Other literature suggested that normal to low CP may be better than excessively high CP as injury is less likely to occur when CP was maintained at ≤20 cm H 2 O while maintaining adequate ventilation [12,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the minimal leak technique (MLT) is similar to the MOV, yet a volume of air is slowly withdrawn from the inflated cuff, while auscultating over the trachea until a leak is heard and this is recorded as the MLT. At which time air is then added to stop the cuff leak [12]. The MLT and MOV are methods routinely used in ICUs, but often result in higher CP when compared with those obtained by cuff pressure manometer [12].…”

Section: Introductionmentioning

confidence: 99%

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Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation

et al. 2020

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Background: While uncuffed endotracheal tubes have been traditionally used in the pediatric intensive care unit (PICU) population, evidence suggests cuffed endotracheal tubes (ETTs) are also safe to use within this population. Nevertheless, risks related to the use of cuffed ETTs increase when guidelines for safe and appropriate use are not followed. The primary goal of this study was to measure the cuff pressure (CP) using a cuff pressure manometer in a group of intubated pediatric subjects and determine the rate of cuff underinflation (<20 cm H 2 0) or overinflation (>30 cm H 2 0). The secondary aim was to determine whether CP was associated to gender, age, ETT size, and PICU length of stay prior to CP measurement. Methods: This was a prospective observational study conducted in an urban PICU. Pediatric subjects intubated with cuffed ETTs from 1 April 2017 to 1 May 2017 were included in the study. ETT CPs were measured daily to determine degree of inflation and compared according to gender, age, ETT size, and number of days intubated prior to CP measurement. Descriptive data are expressed as means and standard deviations. A two-sample t test was used to compare groups according to age, gender, and number of days present. And significance was considered with a P < 0.05. Pearson chi test was used to evaluate correlation between CPs and size of the ETT, number of days intubated prior to CP measurement, gender, and age. Results: Twenty pediatric subjects admitted during the study period were included for analysis. Eleven cuff measurements were found to be within normal limits, while 9 cuff measurements were found to be underinflated. No cases of overinflation were found. There were no significant associations between CP and size of the ETT (r = -0.08), number of days intubated prior to CP measurement (r = 0.19), gender (r = 0.09), and age (r = 0.12). Conclusions:Our study suggests that endotracheal cuff underinflation occurs often in the PICU population. Strategies to ensure appropriate ETT CPs are maintained are essential in the intubated pediatric population. Additional studies are necessary to develop interventions and training focused on the use of a cuff pressure manometer to measure CPs in the PICU by respiratory therapists and ensure consistent measurement using inter rater evaluation processes are needed.

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“…ARTICLE performed in isolation have been shown, in both adult and paediatric studies, to result in a CP outside the recommended range. [12][13][14] A survey on the minimal occlusion volume technique showed variation in technique, which may reduce efficacy. [15] If pressures above 30 cmH 2 O are required to achieve an adequate seal, the tracheal tube is likely to be too small and replacement is recommended.…”

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confidence: 99%

Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital

2019

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Cuffed tracheal tubes are used to prevent loss of tidal volume during positive pressure ventilation, minimise pulmonary aspiration of gastric and oral secretions, facilitate respiratory monitoring and, in the paediatric population, reduce the need for repeated laryngoscopy due to incorrect tube size. [1][2][3] These goals are achieved by appropriate cuff inflation. Cuff pressure (CP) should be >25 cmH 2 O to prevent aspiration and <30 cmH 2 O to avoid damage to surrounding structures. [4,5] Obstruction to blood flow occurs when CP exceeds capillary perfusion pressure, resulting in ischaemia of the tracheal mucosa. Blood flow is impeded at CP ≥30 cmH 2 O in normotensive adult patients, with total obstruction of flow occurring at CP ≥50 cmH 2 O. [5] No paediatric studies have been performed to assess capillary perfusion pressure or the CP at which tracheal capillary blood flow is impeded. The extent of damage from increased CP is related to the absolute pressure exerted by the cuff and the duration of this pressure (mucosal damage is noted to occur within 15 minutes of exposure to high pressures), with a greater contribution being from the absolute pressure. [5,6] Injuries from high CP range from mucosal ulceration to tracheo-oesophageal fistula. [6,7] Low CPs are also associated with risks, including the development of ventilator-associated pneumonia secondary to aspiration and compromised ventilation resulting from loss of positive pressure. [1,8] Internationally accepted consensus guidelines for optimal CP range and frequency of measurement are lacking. [9] A local nursing guideline suggests a CP range of 25 -30 cmH 2 O. [10] The 2015 American Heart Association Pediatric Advanced Life Support guidelines recommend using the manufacturer's specification for appropriate CP in children <9 years and suggest a reference range of 20 -25 cmH 2 O. [11] CP should be measured using a manometer or pressure transducer, as techniques such as digital palpation and the minimal leak technique Background. Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. Objectives. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventional component. In the final stage nurses completed a self-administered questionnaire. Results. A total of 304 charts from 61 patients were reviewed. Patients' ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of ...

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The Minimal Leak Test Technique for Endotracheal Cuff Maintenance

Cited by 16 publications

References 18 publications

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation

Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital

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