Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

Abstract

Background:Positional change affects the cuff pressure of an endotracheal tube (ETT) in treacheally intubated patients. We compared the cuff pressure of a TaperGuard ETT and a cylindrical ETT after lateral rotation of head during middle ear surgery.Methods:Fifty-two patients aged 18–70 years underwent a tympanomastoidectomy under general anesthesia were randomly allocated to receive endotracheal intubation with cylindrical (group C, n = 26) or TaperGuard ETTs (group T, n = 26). After endotracheal intubation, the ETT cuff pressure was set at 22 cmH2O in the neutral position of head. After lateral rotation of head, the cuff pressure was measured again and readjusted to 22 cmH2O. In addition, the change of distance from the carina to the tip of the ETT was measured before and after the positional change. The incidence of cough, sore throat, and hoarseness was assessed at 30 minutes, 6 hours, and 24 hours after surgery.Results:There was no difference in demographic data between groups. After lateral rotation of head, the cuff pressure significantly increased in group T (11.9 ± 2.3 cmH2O) compared with group C (6.0 ± 1.9 cmH2O) (P < 0.001). The incidence of a cuff pressure >30 cmH2O was higher in group T (96.2%) than in group C (30.8%) (P < 0.001). In addition, the degree of displacement of an ETT was greater in group T (11.0 ± 1.7 mm) than in group C (7.2 ± 2.6 mm) (P < 0.001). The overall incidences of postoperative sore throat, hoarseness, and cough at 30 minutes, 6 hours, and 24 hours after surgery were comparable between two groups.Conclusion:The cuff pressure was higher in the TaperGuard ETT than in the cylindrical ETT after positional change of head from neutral to lateral rotation. In addition, after a positional change, the extent of displacement of ETT was greater in the TaperGuard ETT than in the cylindrical ETT.

Comparison of the cuff pressures of a TaperGuard endotracheal tube during ipsilateral and contralateral rotation of the head

“…Another previous study showed that head rotation toward the side of tube fixation increased the cuff pressure in TaperGuard tubes. [ 7 ] In the present study, we found that the increase in cuff pressure with head rotation was significantly lower on the side opposite to tube fixation than on the same side of tube fixation. There was no cuff pressure greater than 30 cmH 2 O on the side opposite to tube fixation, whereas 21 (72.4%) measurements were over 30 cmH 2 O on the same side of tube fixation.…”

“…[ 5 , 6 ] However, in 1 study, the cuff pressure was higher in the TaperGuard endotracheal tube than in the cylindrical endotracheal tube after head rotation. [ 7 ] The same study showed that head rotation toward the side of tube fixation increased the cuff pressure and resulted in withdrawal of the tip of the TaperGuard tube. [ 7 ] Moreover, in a study by Kim et al, where a cylindrical endotracheal tube was used, the tube tip was displaced away from the carina when the head was rotated toward the side of tube fixation; when the head was rotated toward the opposite side, the tube was displaced in an inconsistent manner, showing no movement, withdrawal, or advancement of the tube tip.…”

“…[ 7 ] The same study showed that head rotation toward the side of tube fixation increased the cuff pressure and resulted in withdrawal of the tip of the TaperGuard tube. [ 7 ] Moreover, in a study by Kim et al, where a cylindrical endotracheal tube was used, the tube tip was displaced away from the carina when the head was rotated toward the side of tube fixation; when the head was rotated toward the opposite side, the tube was displaced in an inconsistent manner, showing no movement, withdrawal, or advancement of the tube tip. [ 8 ] In the study by Kim et al, only the tube position was assessed in relation to head rotation, whereas changes in cuff pressure were not observed; moreover, they used a conventional cylindrical endotracheal tube.…”

Is continuous better than intermittent control of tracheal cuff pressure? A meta‐analysis

“…First, it is rather difficult to blindthe investigators and health care staffin this kind of clinical trial; blinding the personnel about the outcome assessment in these included RCTs is not enough, and therefore, publication bias cannot be entirely controlled for. Secondly, we have not performed any subgroup analysis in terms of the material and shape of the tracheal cuff, which are closely related to the patient's prognosis (Zanella et al, ; Madjdpour et al, ; Choi et al, ). Third, becauseof data limitation, the effects of continuous control of P cuff on microaspiration of oropharyngeal secretions or gastric refluxes have not been evaluated, and future studies should focus more on the mechanisms of P cuff for VAP prevention.…”

Effect of lateral positioning on the bronchial cuff pressure of a left-sided double-lumen endotracheal tube during thoracic surgery: study protocol for a prospective observational study

“…Several studies have demonstrated alterations in the cuff pressure of the ETT in response to repositioning of the patient. The cuff pressure of single-lumen ETTs has been found to change when patients undergoing general surgery are moved from the supine position to the prone12 or lateral frank13 position and when the head is shifted from the neutral position to another position 14 15. Such changes in cuff pressure have been reported to occur primarily because of displacement of the tube within the trachea 13.…”