Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES)

Abstract

A bstract Objective To study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment. Materials and methods This was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg. Results Out of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables. Conclusion Our findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098). Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737 How to cite this article Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181–184.

Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study

“…Moreover, neck flexion is especially vulnerable to increased cuff pressure ( 21 , 22 ). Since a raise in cuff pressure is highly associated with postoperative airway complications, such as stridor and sore throat ( 4 , 17 , 23 ), it is appropriate to minimize changes in the patient’s neck posture. Nevertheless, movement of the head and neck is necessary to facilitate surgical access, and a typical example is otorhinolaryngologic surgery, as well as thyroid surgery and cervical spine surgery ( 24 ).…”

“…High pressure in the ETT cuff produces ischemic changes in the tracheal mucosa and compresses the structures around the cuff (2), which can result in critical complications, such as vocal cord paralysis, recurrent laryngeal nerve injury, tracheal stenosis, and tracheal rupture (3). Conversely, insufficient cuff pressure can lead to a significant leak around the ETT or microaspiration (4). Thus, many anesthesiologists recommend that the ETT cuff pressure should be adjusted to an appropriate level (5)(6)(7).…”

Predictores de obstrucción alta de vías respiratorias posterior a la extubación en niños graves

“…ya que, como lo describieran Deakers y cols., el uso de TET con balón no pareciera ser un factor de riesgo de estridor post extubación en pacientes pediátricos tomando recaudos necesarios con respecto al control de la presión del mismo 37,38 . En relación a esto existe controversia sobre cuál es el mejor método para el control de la presión del balón en pacientes pediátricos 39 . Shaikh y cols.…”

Respiratory Complications Between Cuffed and Uncuffed Endotracheal Tubes in Pediatric Respiratory Management After Palatoplasty: Single-Center Retrospective Cohort Study

“…A recent adult study suggested that persistent monitoring of cuffed pressure reduces the occurrence of post-extubation stridor and ventilator-associated pneumonia ( 16 , 17 ). However, a single-center prospective randomized controlled study conducted in a pediatric population showed that protocolized 6-hourly monitoring of ETT cuff pressure in comparison with cuff inflation on each occasion owing to bedside clinical assessment did not reduce the risk of ventilator-associated pneumonia ( 18 ). Therefore, a prospective study with stricter management of cuff pressure is needed.…”