Cuff Pressure of Endotracheal Tubes After Changes in Body Position in Critically Ill Patients Treated With Mechanical Ventilation

Abstract

Background In order to avoid microaspiration and tracheal injury, the target for endotracheal tube cuff pressure is 20 to 30 cm H 2 O. Objective To assess the effect of changes in body position on cuff pressure in adult patients. Methods Twelve orally intubated and sedated patients received neuromuscular blockers and were positioned in a neutral starting position (backrest, head-of-bed elevation 30º, head in neutral position) with cuff pressure at 25 cm H 2 O. Then, 16 changes in position were performed: anteflexion head, hyper extension head, left and right lateral flexion of head, left and right rotation of the head, semirecumbent position (head-of-bed elevation 45°), recumbent position (head-of-bed elevation 10°), horizontal backrest, Trendelenburg position (10°), and left and right lateral positioning over 30°, 45°, and 90°. Once a patient was correctly positioned, cuff pressure was recorded during an end-expiratory ventilatory hold. The pressure observed was compared with the cuff pressure at the starting position. Values outside the target range (20-30 cm H 2 O) were considered clinically relevant. Results A total of 192 measurements were performed (12 subjects x 16 positions). A significant deviation in cuff pressure occurred with all 16 changes (P < .05). No pressures were less than the lower limit (20 cm H 2 O). Pressures were greater than the upper limit (30 cm H 2 O) in 40.6% of the measurements. In each position, the upper target limit was exceeded at least once. Within-patient variability was substantial (P = .02). Conclusion Simple changes in patients' positioning can result in potentially harmful cuff pressures.

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

“…According to a previous study, 26 the mean (SD) TaperGuard ETT cuff pressure was increased by 6.5 (3.9) cm H 2 O after the positional change from the supine to the lateral decubitus position. Assuming that the difference in the mean cuff pressure between the two ETTs is reduced by 50% (3.25 cm H 2 O), we calculated that 23 patients would be needed in each group with a = 0.05 and b = 0.20.…”

“…When the ETT cuff pressure reaches 30 cm H 2 O, blood flow in the tracheal mucosa begins to decrease. 2,26 Moreover, one case in group T showed a cuff pressure of 60 cm H 2 O, an amount that is known to block the circulation of the trachea completely. 4 Tracheal mucosal blood flow can be influenced by various factors such as perfusion pressure and vasomotor status.…”

“…The ETT cuff was inflated with air, and the cuff pressure was set initially at 20 cm H 2 O without air leakage. 1,2,8,26,27 The volume of air supplied to attain the cuff pressure of 20 cm H 2 O was noted. The pressure was measured during an end-expiratory hold using a calibrated cuff manometer (Portex, Smiths Medical, Germany).…”

Tracheal cuff pressure change before and after the performance of nursing care

“…Then, it was adjusted to 25 cmH 2 0 before the beginning of nursing procedures. This parameter was suggested by the Brazilian recommendations of mechanical ventilation 2013 (9) . Just after the procedure is accomplished, all the parameters were rechecked and corrected when necessary, which occurred consecutively in three times (day, evening, and night).…”

“…Cuff pressure is essential in endotracheal tube management. The tubes facilitate positive-pressure ventilation and reduce aspiration of subglottic secretions (9) . Several interventions have been used to reduce the cuff pressure and decrease the incidence of associated adverse consequences.…”