Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck

Abstract

Background: Endotracheal tube (ETT) with a tapered-shaped cuff had an improved sealing effect when compared to ETTs with a conventional cylindrical-shaped cuff. Positional change and neck movement typically displace an ETT and change the intracuff pressure. The aim of the current study was to compare the ETT cuff pressure in the TaperGuard ETT vs the conventional ETT after a change from the supine, neutral position to the extension of the neck and semi-Fowler position for thyroid surgery.Methods: This prospective, randomized clinical trial included 50 patients undergoing thyroidectomy. Patients were randomly allocated into one of the 2 groups: tracheal intubation with the TaperGuard ETT or with a conventional ETT. The ETT cuff was inflated with air and the ETT cuff pressure was set initially at 20 cmH 2 O using a calibrated cuff manometer. ETT cuff pressure and distance from carina to ETT tip were measured at supine and semi-Fowler positions with neck extension.Results: After the position change, the ETT tip migrated cephalad and cuff pressure increased in the majority of cases. ETT cuff pressure was significantly higher in the TaperGuard group than the conventional group (28.0 ± 6.6 cmH 2 O and 22.8 ± 4.5 cmH 2 O, respectively, P = .001). The degree of cephalad displacement of the ETT tip was comparable between the 2 groups (19.4 ± 6.31 mm in TaperGuard group and 21.9 ± 6.9 mm in conventional group, P = .12).Conclusions: After the position change from supine to hyperextension of the neck, the ETT cuff pressure was higher in the TaperGuard ETT than in the conventional ETT, although the extent of displacement of the ETT was comparable between the 2 groups.

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

“…Other investigators have reported a larger increase in tapered cuff pressures than in cylindrical cuff pressures after neck extension, rotation, or change of position ( 16 – 18 ). Differences in study design, including the site or type of surgery and the selection of baseline pressures, likely explain the unique findings of different studies.…”

“…extension, rotation, or change of position (16)(17)(18). Differences in study design, including the site or type of surgery and the selection of baseline pressures, likely explain the unique findings of different studies.…”

“…Differences in study design, including the site or type of surgery and the selection of baseline pressures, likely explain the unique findings of different studies. For example, some studies used a baseline pressure of 15 mm Hg (20 cm H 2 O) for all study patients (16)(17)(18), regardless of the sealing pressure determined by clinical auscultation, whereas we used the just-seal pressure for every patient. Previous studies reported a greater risk of postoperative vocal cord palsy in patients who have surgery at the C6/7-T1 level (6,37,38).…”

“…Some investigators have reported a larger increase in tapered cuff pressures, compared with that of cylindrical cuffs, after neck extension, rotation, or a change of position in small study cohorts while others have not (16)(17)(18). To fully address the effects of cuff shape on pressure after surgical retraction during anterior cervical spine surgery, we conducted a randomized double-blind controlled study using a population sample that was calculated for power of analysis.…”

Endotracheal Tube Overinflation Leading to Hypoxic Cardiac Arrest: A Case Report and Review of the Literature

“…These results indicate that N2O diffusion in the cuff inflated with air may result in tracheal mucosal erosion and sore throat perioperatively [16]. Hyperextension of the neck has also been shown to increase ETT cuff pressure [17]. This is an important consideration in surgeries that require fixation of the head such as ear, nose, and throat, and neurosurgeries.…”