Clinical evaluation of stethoscope‐guided inflation of tracheal tube cuffs

Kumar, Rakesh; Hirsch, Nicholas

doi:10.1111/j.1365-2044.2011.06853.x

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…14 The mean volume of air in endotracheal tube cuff in Group Jwas 4.82 ± 0.72 ml and Group Swas 4.58 ± 0.70 ml which was comparable (p-value 0.095) in this study. Although the volume of air in study done by Kumar et al 15 was higher in Just Seal group [5.4 ml (1.2)] and stethoscope guided [5.4 ml (2.0)] group than this study, it was not significant which is similar to this study. Studies by Sengupta et al 9 and Bolzan et al 16 showed similar volume of air 4.4 ± 1.8 ml and 4.59 ± 0.45 ml respectively in the endotracheal tube cuff by just seal technique as in this study.…”

Section: Journal Of Society Of Anesthesiologists Of Nepalsupporting

confidence: 69%

Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

Rajbhandari

Kunwar

et al. 2019

J. Soc. Anesth. Nep.

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Background: Overinflation of the endotracheal tube cuff affects tracheal mucosa blood supply that causes postoperative complications like cough, sore throat and hoarseness. There is no standard cuff inflation technique that produces appropriate cuff pressure. The aim of this study was to find out better technique of cuff inflation that will produce adequate pressure with limited complication using stethoscope guided and “just seal”. Methods: This was prospective, randomized single blinded study of 100 American Society of Anesthesiologists Physical Status (ASA PS) I and II patients of 18-65 years undergoing elective surgery under general anesthesia requiring endotracheal intubation. Group J (n=50) received ‘just seal’ method of tracheal cuff inflation where air was introduced into cuff until audible leak at mouth disappeared and Group S (n=50) received stethoscope-guided tracheal cuff inflation where air was introduced into cuff until harsh breath sound changed to soft while listening with stethoscope bell over the thyroid cartilage. Volume of air in endotracheal tube cuff, cuff pressure following inflation and post-operative sore throat, hoarseness and cough at 24 hour were assessed. Results: Demographic details, mean volume of air in cuff, mean cuff pressure and incidence of postoperative adverse effects like sore throat, hoarseness and cough at 24 hours between the groups were comparable. Conclusion: Both the stethoscope guided and “just seal” cuff inflation techniques were equally effective in producing adequate cuff pressure of 20-30 cmH2O with limited complication.

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Section: Journal Of Society Of Anesthesiologists Of Nepalsupporting

confidence: 69%

Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

Rajbhandari

Kunwar

et al. 2019

J. Soc. Anesth. Nep.

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“…[ 12 ] Although efforts were made to keep the ETT cuff pressure within the recommended pressure range, there is no reliable method to ensure its occurrence. [ 13 14 ] Several methods were developed to ensure proper cuff inflation, such as minimal leak technique,[ 15 ] minimal occlusive volume,[ 16 ] ETT cuff inflation to a minimum pressure level,[ 17 ] stethoscope-guided cuff inflation[ 18 ] and the conventional technique in which an undetermined volume of air is used to inflate the cuff. [ 19 ] Fernandez et al .…”

Section: Discussionmentioning

confidence: 99%

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

Almarakbi

Kaki

2014

Saudi J Anaesth

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Background:The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness.Materials and Methods:In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported.Results:Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001).Conclusions:The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications.

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“…12,13,17 Kumar and Hirsch reported median cuff pressure of 34 cm H2O in JS group and; Sixty-four per cent of cuff pressures exceeded the recommended level of 30 cm H2O and only 32% of cuff pressures fell within the recommended range; 4% of pressures were < 20 cmH2O. 6 While in this study the median tracheal cuff pressure was 12 cm H2O. Only 25% of the patient's cuff pressures fell within the recommended range, 75% of cuff pressures were <20 cm H2O and none of cuff pressures exceeded the recommended level of 30 cm H2O.…”

Section: Discussionmentioning

confidence: 94%

“…Kumar and Hirsch reported median cuff pressure of the 20 (20-26 [16][17][18][19][20][21][22][23][24][25][26][27][28]) cm H2O in the stethoscope-guided group, 84% of pressures fell within in the recommended range of 20-30 cmH2O and no pressures >30 cm H2O were recorded; 16% of pressures were <20 cmH2O. 6 The difference in the results can be because of different methodology used in both studies. Mean volume of air introduced in the cuff was 5.4 ml in both the groups as compared to 4.0 ml and 4.2 ml in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Adequacy of ETT cuff inflation is usually checked by one of the following techniques: Manual palpation of the pilot balloon, disappearance of audible air leak through the mouth or disappearance of palpable air leak at thyroid cartilage or suprasternal notch (Just seal), auscultation of leak at right lamina of thyroid cartilage (stethoscope guided) or use of either an aneroid manometer or continuous automatic ETT cuff pressure controller. 5,6 Pressure-volume loop (PVL) is one of the continuous real time pulmonary graphic incorporated in the monitoring system of anaesthesia machines and mechanical ventilators. Usually, it is used for the assessment of dynamic lung compliance, detection of lung over inflation or presence of air leak.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

et al. 2020

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Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

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Clinical evaluation of stethoscope‐guided inflation of tracheal tube cuffs

Cited by 18 publications

References 33 publications

Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial

Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

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