Tracheal Ulcers Due to Endotracheal Tube Cuff Pressure

Álvarez-Maldonado, Pablo; Vidal, E.; Cerón-Díaz, Ulises

doi:10.1097/lbr.0b013e318228f703

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…We would disagree. FOB guidance for percutaneous tracheostomy increases the safety margin of the procedure and allows tracheal examination and confirmation of correct tracheostomy placement [34][35][36]. We considered FOB useful in these cases only if adequate visualization and airway control were achieved during the entire process.…”

Section: Discussionmentioning

confidence: 99%

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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is properly cited.Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48 ± 17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO 2 ) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

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Section: Discussionmentioning

confidence: 99%

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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“…6,19 This could present a patient safety concern, as elevated cuff pressures have been associated with adverse patient outcomes including tracheal stenosis, tracheal ulcer, tracheal rupture, and tracheoesophageal fistula. [9][10][11][12] This study has provided evidence that supports the adoption and integration of cuff pressure recording both for prehospital services and as a part of respiratory protocol for teams receiving intubated patients from the prehospital setting. Further study may entail training EMS providers on taking ETT cuff pressure measurements to shift the task of cuff pressure quality assurance to the field.…”

Section: Summary and Further Researchmentioning

confidence: 60%

“…8 When the pressure of the ETT cuff against the mucosa is equal to or greater than the perfusion pressure of the local capillary vessels, effectively occluding blood flow and impairing perfusion, complications including tissue ischemia, necrosis, scarring, and stenosis of the tracheal wall may develop. [8][9][10][11] This can lead to serious complications including tracheal ulcer, tracheal rupture, and tracheoesophageal fistula. [9][10][11][12] In addition, there are also several animal studies that describe a similar effect and relationship between elevated ETT cuff pressure and capillary blood flow to tracheal lumen.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] This can lead to serious complications including tracheal ulcer, tracheal rupture, and tracheoesophageal fistula. [9][10][11][12] In addition, there are also several animal studies that describe a similar effect and relationship between elevated ETT cuff pressure and capillary blood flow to tracheal lumen. 13,14 Despite it being considered a component in the standard of care in ETT management and prior studies supporting the use of cuff pressure recording in various clinical settings, ETT cuff pressures are not routinely recorded in prehospital patient care records or in hospital medical records.…”

Section: Introductionmentioning

confidence: 99%

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Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

Chen

O’Connor

Rebesco

et al. 2021

Prehosp. Disaster med.

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Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

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“…It has been proven that during palpation assessment, the cuff seal is overin ated, even to as high as 100 cm H2O [4]. Application of incorrect pressure in the endotracheal tube cuff seal can be extremely worrying as it may cause numerous complications [6][7][8][9][10][11]. In pre-hospital paramedic treatment, intubation is often used as the chosen method for clearing the airways.…”

Section: Introductionmentioning

confidence: 99%

Endotracheal tube cuff pressure – how fast paramedics can learn the optimal inflation? - comparison of different methods

Ilczak

Ćwiertnia

Białoń

et al. 2020

Preprint

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Background Tracheal intubation is the optimal method for opening up the airways. Performed correctly, it prevents stomach contents from entering the respiratory tract, and allows asynchronous CPR to be conducted during sudden cardiac arrest. An important element of correct intubation is proper inflation of the endotracheal tube cuff. Research has shown that when medical personnel use the palpation technique, the cuff is usually inflated incorrectly. This can result in numerous health complications for the patient. Methods This research was conducted in 2020 on a group of paramedics participating in the 15th International Winter Championship of Medical Rescuers in Bielsko-Biała. The aim of the research was to assess two methods of inflating the endotracheal tube cuff. Method A involved inflating the cuff using a syringe and assessing the pressure in the control cuff using the palpation technique. Method B involved inflating the cuff using a manometer. During the inflation, both the cuff inflation pressure and the time required to complete the procedure were recorded. Analysis was also conducted on whether completion of certified ALS and ACLS training had any influence on the effectiveness of the inflation procedure. Results The research showed that paramedics using method B significantly more often inflated the endotracheal tube cuff to the correct pressure than those using method A. However, when method B was used, the procedure took longer to conduct. The study also showed that completion of certified ALS or ACLS training did not have a significant influence on proper inflation of the cuff. Those who had completed certified training courses took significantly longer to inflate the endotracheal tube cuff when using method A. Conclusions Inflation of the endotracheal tube cuff by use of a syringe, followed by the palpation technique for assessing the inflation of the cuff balloon is ineffective. Paramedic teams should be equipped with manometers to be used for inflating the endotracheal tube cuff.

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Tracheal Ulcers Due to Endotracheal Tube Cuff Pressure

Cited by 5 publications

References 8 publications

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

Endotracheal tube cuff pressure – how fast paramedics can learn the optimal inflation? - comparison of different methods

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