Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation

Abstract

Background Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.

Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator

“…25 P is consistently reported to be an inaccurate cuff inflation technique, with overinflation frequently reported in both simulator-based and in vivo human and veterinary models. 15,17,21,30,31 Pisano et al postulated that P is frequently reported to be an inaccurate technique because the smaller radius of the pilot balloon creates a lower wall tension (Law of Laplace) when compared with the larger endotracheal cuff; therefore, predisposing to overinflation. 32 This theory may, in fact, also explain the tendency for underinflation seen in the current study as the ETT used (Microcuff Paediatric Endotracheal Tube 4.5 mm; Halyard) has a cuff that is smaller than the pilot balloon.…”

“…16 Lately, the loss-of-resistance technique (LOR) has been tested in human anaesthesia. [19][20][21] In this case, the operator uses a plastic loss-of-resistance syringe to temporarily overinflate the cuff and then allow the passive release of excess pressure. More recently, a novel syringe device with digital pressure indicator has become available (AG Cuffill; Provet).…”

Measuring endotracheal tube intracuff pressure: no room for complacency

“…Similar to the palpation technique, this method is also prone to errors but might have better acceptability amongst practicing clinicians [46,64]. Bulamba et al [65] recommended using a loss of resistance syringe as a viable option to simple palpation method. A 7 ml plastic, luer slip, loss of resistance syringe containing air into the pilot balloon and the loss of resistance syringe plunger could passively draw back until it ceased.…”

Hıgh Intraoperatıve Cuff Pressure Incıdence Due to Endotracheal Cuff Inflatıon Methods And Its Clınıcal Effects

“…Endotrakeal entübasyon sonrası gelişen yutma güçlüğü sıklığı %16-60 arasındadır (17) . Manometre kullanılmaksızın kaf basıncının ayarlandığı bir çalışmada %14 oranında yutma güçlüğü görülmüştür (18) . Benzer şekilde bizim çalışmamızda da bu oran %14.6 olarak bulunmuştur.…”

“…Ses kısıklığının nedenleri; vokal kordlarda endotrakeal entübasyondan kaynaklanan ödem, mekanik temas ve tüpün glottik alanda oluşturduğu abrazyonun yanı sıra kaf basıncındaki aşırı inflasyonun lokal inflamasyonu arttırmasıdır (15,19) . Endotrakeal kaf inflasyon yöntemi olarak pilot balon palpasyonu ve direnç kaybı yöntemi kullanılan bir çalışmada, ses kısıklığı sıklığı %9 olarak bildirilmiştir (18) Kim ve ark. (20) , baş pozisyonunun değiştirilmesiyle kaf basınçlarının değiştiğini göstermiştir.…”