A Tapered Cuff Tracheal Tube Decreases the Need for Cuff Pressure Adjustment After Surgical Retraction During Anterior Cervical Spine Surgery: A Randomized Controlled, Double-Blind Trial

Abstract

BackgroundSurgical retraction to expose the vertebrae during anterior cervical spine surgery increases tracheal tube cuff pressure and may worsen postoperative sore throat and dysphonia. This randomized double-blind study investigated the effect of cuff shape on intraoperative cuff pressure and postoperative sore throat and dysphonia.MethodsEighty patients were randomized to tracheal intubation with a tapered cuff or a conventional cylindrical high-volume low-pressure cuff (control) during anesthesia. Intraoperative cuff pressures were compared. The primary outcome was the incidence of pressure adjustment needed when the cuff pressure increased to > 25 mm Hg after surgical retraction. The secondary outcome was the incidence of postoperative sore throat and dysphonia.ResultsThe incidence of pressure adjustment after surgical retraction was significantly lower in the tapered group than in the control group (13% vs. 48%; P = 0.001; relative risk reduction, 74%). The median [interquartile range (IQR)] cuff pressure (mm Hg) was significantly lower for the tapered cuff than for the control cuff before surgical retraction [9 (7–12) vs. 12 (10–15); P < 0.001] and after retraction [18 (15–23) vs. 25 (18–31); P = 0.007]. The median (IQR) postoperative dysphonia score assessed by a single speech-language pathologist was lower in the tapered group than in the control group [4 (3–6) vs. 5.5 (5–7); P = 0.008].ConclusionA tapered cuff tracheal tube decreased the need for the adjustment of cuff pressure after surgical retraction during anterior cervical spine surgery, thereby avoiding intraoperative pressure increase. It also has a better outcome in terms of dysphonia.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT04591769].

Determination of Factors Affecting Endotracheal Tube Cuff Pressure in Adult Patients in Intensive Care Unit

“…In another study, it was found that ET with a conical cuff caused significantly less gastric secretion leakage compared to cylindrical cuffed tubes and was more effective in preventing the development of VAP (32,33) . In a study conducted in patients undergoing cervical surgery, it was found that the ETCP value measured in the conical cuff changed much less frequently during surgery and the cuff pressure was lower than in cylindrical cuffed endotracheal tubes (34) .…”

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

“…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 ). Therefore, we suggest that continuous monitoring of the ETT cuff pressure should be implemented, especially in otorhinolaryngologic surgeries requiring position changes near the airway.…”

Hygiene auf der Intensivstation – Minimierung nosokomialer Infektionen

“…Neue technische Entwicklungen wie dünne Materialien für Cuffmanschetten oder die Form des Cuffs (Konus) mit dem Ziel der besseren Abdichtung konnten bisher in klinischen Studien zur Prävention der VAP nicht überzeugen [13,14]. Allerdings gibt es nun Hinweise, dass eine bessere intraoperative Abdichtung bei Manipulationen am Hals mit einem konischen Cuff gelingen kann [15].…”