Air leakage around endotracheal tube cuffs

Dullenkopf, Alexander; Schmitz, A.; Frei, Martina; Gerber, Andri; Weiß, Markus

doi:10.1017/s0265021504006064

Cited by 46 publications

(50 citation statements)

References 20 publications

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“…Underinflation of the endotracheal tube cuff is associated with inadequate delivery of prescribed tidal volume and aspiration of secretions. 6,18,23,[28][29][30][31][32][33][34][35][36] Dullenkopf et al 37 reported that a pressure of 19.1 cm H 2 O was required for an adequate seal of an endotracheal tube cuff. After a study of 83 patients who were intubated with an endotracheal tube that provided continuous aspiration of subglottic secretions, Rello et al 6 recommended a minimum pressure of 20 cm H 2 O.…”

Section: Background Importance Of Cuff Pressure Managementmentioning

confidence: 99%

Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

Sole

Penoyer

et al. 2009

American Journal of Critical Care

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Background Endotracheal tube cuff pressure must be maintained within a narrow therapeutic range to prevent complications. Cuff pressure is measured and adjusted intermittently. Objectives To assess the accuracy and feasibility of continuous monitoring of cuff pressure, describe changes in cuff pressure over time, and identify clinical factors that influence cuff pressure. Methods In a pilot study, data were collected for a mean of 9.3 hours on 10 patients who were orally intubated and receiving mechanical ventilation. Sixty percent of the patients were white, mean age was 55 years, and mean intubation time was 2.8 days. The initial cuff pressure was adjusted to a minimum of 20 cm H 2 O. The pilot balloon of the endotracheal tube was connected to a transducer and a pressure monitor. Cuff pressure was recorded every 0.008 seconds during a typical 12-hour shift and was reduced to 1-minute means. Patient care activities and interventions were recorded on a personal digital assistant. Results Values obtained with the cufflator-manometer and the transducer were congruent. Only 54% of cuff pressure measurements were within the recommended range of 20 to 30 cm H 2 O. The cuff pressure was high in 16% of measurements and low in 30%. No statistically significant changes over time were noted. Endotracheal suctioning, coughing, and positioning affected cuff pressure. Conclusions Continuous monitoring of cuff pressure is feasible, accurate, and safe. Cuff pressures vary widely among patients.

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Section: Background Importance Of Cuff Pressure Managementmentioning

confidence: 99%

Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

Sole

Penoyer

et al. 2009

American Journal of Critical Care

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“…Initially, it was thought that the material used in the standard polyvinyl ETT cuffs was the cause of the microchannel formation. 32,33 A new cuff made of polyurethane material that has an ultrathin cuff membrane (thickness of 7 m m compared with a thickness of . 50 m m in the conventional HVLP ETT) may prevent the formation of folds within the ETT cuff.…”

Section: Cuff Materials and Shapementioning

confidence: 99%

Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia

Fernandez

Levine

Restrepo

2012

Chest

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231V entilator-associated pneumonia (VAP) is a common complication in patients on mechanical ventilation (MV). Depending on the surveillance methods used for the diagnosis of VAP, the risk of this complication ranges from 1.2 to 8.5 cases per 1,000 ventilatordays (0.6%-4%). 1 VAP is associated with increased hospital length of stay, mortality, infections due to multidrug-resistant pathogens, and an attributable hospital cost of approximately $10,000 to $25,000. 2,3 Therefore, preventive measures that could impact the incidence of VAP in the ICU setting must be considered a priority, because they could improve the safety of patients in the ICU. Multiple interventions are used to prevent VAP; however, there is a growing interest in those interventions related to the endotracheal tube (ETT) as one of the main targets linked to VAP. 2,4 An ETT tube is considered one of the major risk factors for VAP, acting both as a reservoir for potential infecting microorganisms and as a bridge between the oropharyngeal environment and the sterile bronchoalveolar space by bypassing host defenses. 5,6 Moreover, the ETT alters the ability of the host to clear secretions by coughing, and keeps the epiglottis open, allowing the passage of secretions and fluids into the airways.The two most important mechanisms implicated in the development of VAP are microaspiration and biofi lm formation. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. 7 Biofi lm

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“…The cuff has the function to ensure the proper pulmonary ventilation without allowing air leakage (3,(6)(7)(8) , and prevent aspiration of oropharyngeal and gastroesophageal contents into the lungs (3,(6)(7)(8)(9)(10) . The pressure in the cuff is harmful to the tracheal mucosa (6,(9)(10)(11) especially when the pressure setting is not appropriate, using extremely safe values (9)(10)(11) . However, the air volume used to inflate the balloon must not generate higher pressure than the tracheal mucosa perfusion, only a "seal" pressure to enclose de air (7,(10)(11)(12) .…”

Section: Introductionmentioning

confidence: 99%

Measurement reliability of endotracheal tubes cuff pressure between industrial and handmade devices

Cunha¹,

Sales²,

Araújo³

et al. 2020

mtprehabjournal

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Air leakage around endotracheal tube cuffs

Cited by 46 publications

References 20 publications

Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

Technologic Advances in Endotracheal Tubes for Prevention of Ventilator-Associated Pneumonia

Measurement reliability of endotracheal tubes cuff pressure between industrial and handmade devices

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