Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

Abstract

BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n ‫؍‬ 222) and volume-time curve group (n ‫؍‬ 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: The volume-time curve group presented significantly lower cuff pressure (30.9 ؎ 2.8 vs 37.7 ؎ 3.4 cm H 2 O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ؎ 1.8 vs 7.1 ؎ 1.7), better preservation of FVC (49.5 ؎ 9.9 vs 41.8 ؎ 12.9%, P ‫؍‬ .005), and FEV 1 (46.6 ؎ 1.8 vs 38.6 ؎ 1.4%, P ‫؍‬ .005) compared with the MOV group. CONCLUSIONS: The subjects who received the volumetime curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

Does the minimal occlusive volume technique provide adequate endotracheal tube cuff pressure to prevent air leakage?: a prospective, randomized, crossover clinical study

“…Unlike previous studies [10][11][12], this study showed that the cuff pressure was low when measured by the MOV technique. We slowly inflated the cuff with air with 0.2 ml increment at every inspiratory moment until the air leakage sound heard by the stethoscope disappeared.…”

“…Previous studies have reported higher cuff pressures for the MOV technique [10][11][12] than for the spirometer technique. However, we expected that the cuff pressure determined by the spirometer technique would be higher than that determined by the MOV technique because a spirometer is able to detect even small air leakage.…”

Efficiency of a mechanical device in controlling tracheal cuff pressure in intubated critically ill patients: a randomized controlled study

“…Therefore, it is dependent on respiratory flow and airway pressure that may widely vary in critically ill patients. In addition, the key principle is probably an equilibrium between airway pressure and P cuff , which means that the time constant of the system might play a role in the higher P cuff [ 29 , 30 ]. Further, the exact P cuff target, using the mechanical device, could not be precisely determined or modified.…”

Detrimental Effects of Filling Laryngotracheal Airways To Excessive Pressure (DEFLATE-P): a quality improvement initiative

“…Interestingly, Corda et al found that utilizing syringe rebound pressure alone (as a surrogate for measurement of intra-cuff pressure with manometry) was enough to reduce the incidence of POST [16]. In lieu of manometry, it is worthwhile to note two doubleblind, randomized controlled trials that have reported success in reducing postoperative respiratory complications by titration of ETT cuff pressure based on the anesthesia machine volume-time curve and minimizing or eliminating the difference between the inspiratory and expiratory volume [17,18]. None of these interventions, however, completely eliminated POST.…”