Endotracheal tube cuff pressure
need for precise measurement
Keywords:
Tracheal tube, Intracuff pressure, Nitrous oxideAbstract
CONTEXT: High compliance endotracheal tubes cuffs are used to prevent gas leak and also pulmonary aspiration in mechanically ventilated patients. However, the use of the usual cuff inflation volumes may cause tracheal damage. OBJECTIVE: We tested the hypothesis that endotracheal tube cuff pressures are routinely high (above 40 cmH2O) in the Post Anesthesia Care Unit (PACU) or Intensive Care Units (ICU). DESIGN: Cross-sectional study. SETTING: Post anesthesia care unit and intensive care unit. PARTICIPANTS: We measured endotracheal tubes cuff pressure in 85 adult patients, as follows: G1 (n = 31) patients from the ICU; G2 (n = 32) patients from the PACU, after anesthesia with nitrous oxide; G3 (n = 22) patients from the PACU, after anesthesia without nitrous oxide. Intracuff pressure was measured using a manometer (Mallinckrodt, USA). Gas was removed as necessary to adjust cuff pressure to 30 cmH2O. MAIN MEASUREMENTS: Endotracheal tube cuff pressure. RESULTS: High cuff pressure (> 40 cmH2O) was observed in 90.6% patients of G2, 54.8% of G1 and 45.4% of G3 (P < 0.001). The volume removed from the cuff in G2 was higher than G3 (P < 0.05). CONCLUSION: Endotracheal tubes cuff pressures in ICU and PACU are routinely high and significant higher when nitrous oxide is used. Endotracheal tubes cuff pressure should be routinely measured to minimize tracheal trauma.
Downloads
References
Nordin V. The trachea and cuff induced tracheal injury. Acta Otolaryngol 1977;71 (suppl 345):7-71.
Klainer SA, Turndorf H, Wu HW. Surface alterations due to endotracheal intubation. Am J Med 1975;58:674-83.
Martins RHG, Braz JRC, Bretan O. Lesőes precoces da intubaçăo traqueal. Rev Bras Otorrinolaringol 1995;61:343-8.
Berlauk J. Prolonged endotracheal intubation vs. tracheostomy. Crit Care Med 1986;14:742-6.
Stauffer J, Olsen D, Petty HT. Complications and consequences of endotracheal intubation and tracheostomy. Am J Med 1981;70:65-76.
Tempelhoff G, Carton M, Cannamel A. Complications laringotracheales de l'intubation: étude prospective sur 128 patients de réanimation controlés par fibroscopie ŕ 24h ŕ 1 mois. Reanim Soins Intens Med Urg 1986;2:264-9.
Stanley TH, Kamamura R, Serious C. Effects of nitrous oxide on volume and pressure of endotracheal tube cuff. Anesthesiology 1974;41:256-61.
Byrd RA, Mascia MF. What is the endotracheal tube cuff pressure in a cross-section of intubated patients? Anesthesiology 1996;85(suppl 3A):982.
Fernandez R, Blanch L, Mancebo J, Bonsoms N. Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement. Crit Care Med 1990;18:1423-6.
Lewis F, Schlobohm R, Thomas A. Prevention of complications from prolonged tracheal intubation. Am J Surg 1978;135:452-7.
Dobrin P, Canfield T. Cuffed endotracheal tubes: mucosal pressures and tracheal wall blood flow. Am J Surg 1977;133:562-8.
Bunegin L, Albin SM, Smith BR. Canine tracheal blood flow after endotracheal tube cuff inflation during normotension and hypotension. Anesth Analg 1993;76:1083-90.
Joh S, Matsuura H, Kotani Y, et al. Change in tracheal blood flow during endotracheal intubation. Acta Anaesthesiol Scand 1987;31:300-6.
Brandt L. Prevention of nitrous oxide induced increase in endotracheal tube cuff pressure. Anesth Analg 1991;72:262-70.
Fill DM, Dosch MP, Bruni RM. Rediffusion of nitrous oxide prevents increase in endotracheal tube cuff pressure. J Am Assoc Nurse Anesth 1994;62:77-91.
Bouflers E, Menu H, Gérard A, Maslowski D, Reyford H, Guermouche T. Étude comparative des pressions au niveau du ballonet temoin de deux types de sondes d'intubation. Cahiers Anesthesiol 1996;44:499-502.
Metha S, Mickiewicz M. Work practices relating to intubation and associated procedures in intensive care units in Sweden. Acta Anesthesiol Scand 1986;30:637-40.
Tobin MJ, Grenvik A. Nosocomial lung infection and its diagnosis. Crit Care Med 1984;12:191-6.
