Cuffed endotracheal tubes: Mucosal pressures and tracheal wall blood flow

Dobrin, Philip B.; Canfield, Thomas R.

doi:10.1016/0002-9610(77)90008-3

Cited by 87 publications

(49 citation statements)

References 21 publications

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“…Therefore, prophylactic strategies for decreasing sore throat frequency and severity are still recommended. It's self-evident that the complication primarily resulted from the irritation of tracheal mucosal receptors (23,24), which might lead to further local inflammation or/and edema (25). Therefore, blocking these receptors with local anesthetics, such as lidocaine, should be an effective option for preventing ETT-induced sore throat, as demonstrated by previous studies (12,13).…”

Section: Discussionmentioning

confidence: 99%

Effect of Intra-Cuff Tetracaine on Preventing Postoperative Sore Throat after Gynecological Surgery

Zhu¹,

Wu²,

Song³

et al. 2015

J Anesth Perioper Med

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Background: Postoperative sore throat is one of the most common complications associated with endotracheal intubation. It has been reported that intra-cuff application of lidocaine could reduce its incidence and severity. In the present study, we would like to investigate the safety and efficacy of intra-cuff use of tetracaine, one of the most commonly used topical anesthetic, on prevention of postoperative sore throat. Methods: Female patients (age from 18-60 years) undergoing gynecological surgery under general anesthesia were included. Assigned randomly, the patients received one of the following cuff inflation media: air, 0.9% saline, 2% lidocaine or 1% tetracaine (N=25 in each group). The cuff was inflated with minimal occlusive volume technique. Intra-cuff pressure was measured with a manometer. The primary outcome was the severity of postoperative sore throat, assessed by visual analogue scale (VAS) at 6 hours after extubation. The secondary outcomes included the incidences of complications during emergence of anesthesia and extubation, such as tube intolerance, coughing, restlessness, hoarseness, and laryngospasm, as well as the VAS scores for sore throat at 24 and 48 hours after extubation. The safety and efficacy were further tested by pathological examination of tracheal mucosa after 4-hour intubation in animal study and measurement of diffused anesthetic via the cuff wall in in vitro study, respectively. Results: There was no difference in volume of inflation medium, or intra-cuff pressure between groups. Tetracaine significantly reduced the severity of postoperative sore throat during the 48-hour postoperative observation period, compared with lidocaine (P<0.05) or air (P<0.01). There were also fewer patients with tube intolerance, coughing, restlessness and hoarseness in tetracaine group, compared with lidocaine group (P<0.05) or air group (P<0.01). No abnormality was found in tracheal mucosa pathology and tetracaine diffused via the cuff wall continuously. Conclusions: Our study showed that inflating the cuff with tetraciane is safe and effective in preventing tube-induced emergence phenomena.

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Section: Discussionmentioning

confidence: 99%

Effect of Intra-Cuff Tetracaine on Preventing Postoperative Sore Throat after Gynecological Surgery

Zhu¹,

Wu²,

Song³

et al. 2015

J Anesth Perioper Med

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“…Previously, the pressure exerted on the tracheal wall by endotracheal tube cuffs has been estimated using calculations from balloons interposed between cuff and trachea, implantable transducers cuff, gas flowing across the cuff-trachea contact area through hollow sleeves and compliance curves [15][16][17][18]. There are common methodological problems with each technique, which may be categorised under the headings measuring probe error, pressure measurement volume displacement error and volume aliquot inflation error.…”

Section: Discussionmentioning

confidence: 99%

Will the Taper Shaped Cuff Replace the Conventional High Volume-Low Pressured Cuff on Endotracheal Tube?

Hong

2014

Korean J Crit Care Med

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Background: The Lotrach endotracheal tube has a unique low-volume, low-pressure (LVLP) cuff, which has been designed to prevent pressure injury to the tracheal wall. We aimed to estimate the pressure exerted on the tracheal wall by the LVLP cuff and a conventional cuff in a bench-top, clinical and radiological study. Method: In the bench-top study, a model trachea was intubated with the LVLP cuff and the conventional cuff. The cuff pressure was controlled using a constant pressure device. We assessed the pressure exerted on the tracheal wall by measuring the ability of the cuffs to support a column of water using a standard protocol. In the clinical study, we tested the ability of both cuffs to prevent air leak during a staged recruitment manoeuvre. In the radiological study, we recorded the degree of anatomical distortion of the trachea from both cuffs in the anteroposterior (AP) and transverse tracheal diameters. We performed statistical analysis using non-inferiority tests. Results: In the bench-top study, the LVLP cuff achieved a plateau at a mean height of 25.2 cmH2O (SD 0.34). In contrast, the conventional cuff failed to maintain any water above the cuff and a plateau could not be measured. In the clinical study, the mean pressure at which air leak occurred was 30.0 +/-0.8 cmH2O (SD 3.8) using the LVLP cuff and 32.4 +/-0.7 cmH2O (SD 3.0) using the conventional cuff. In the radiological study, the mean degree of anatomical distortion of the trachea in AP and transverse tracheal diameter was 2.9 +/-2.2 mm (SD 2.1) and 1.8 +/-1.4 mm (SD 1.4) using the LVLP cuff and 4.4 +/-1.3 mm (SD 1.4) and 2.6 +/-1.5 mm (SD 1.6) using the conventional cuff. Conclusions: The bench-top and clinical studies both demonstrated that the LVLP cuff exerted approximately 30 cmH2O of pressure on the tracheal wall. These results are supported by our radiological study. We conclude that the LVLP cuff exerts an acceptable amount of pressure on the tracheal wall when it is operated at the recommended intracuff pressure.

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“…13 Third, our data for cadaveric laryngopharyngeal mucosal pressures closely match those of two previous studies of the cuffed oropharyngeal airway in paralyzed anesthetized patients. 11,12 Fourth, cadavers have been used to determine the risk of esophageal rupture, 14 liquid flow between the esophagus and pharynx, 15 pharyngeal and tracheal mucosal pressure 16 and cervical motion studies. 17 Our study was conducted in cadavers and awake volunteers since we considered it unethical to inflate the LTA to the maximum recommended volumes in patients due to the potential for trauma.…”

Section: Studymentioning

confidence: 99%

Un ballonnet de grand volume gêne la perfusion de la muqueuse pharyngienne postérieure réalisée avec le tube d’intubation laryngée

Brimacombe

Keller

Roth

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The laryngeal tube airway (LTA) is a new extraglottic airway device with a large proximal cuff that inflates in the laryngopharynx and a distal conical cuff that inflates in the hypopharynx. We determine the influence of the cuff volume and anatomic location on pharyngeal mucosal pressures for the LTA.M Me et th ho od ds s: : Fifteen fresh cadavers were studied. Microchip sensors were attached to the (anatomic location) anterior, lateral and posterior surface of the distal cuff (hypopharynx) and proximal cuff (laryngopharynx) of the size 4 LTA. Oropharyngeal leak pressure (OLP) and mucosal pressures were measured at 0-140 mL cuff volume in 20-mL increments. In addition, mucosal pressures for the proximal cuff were measured in three awake, topicalized volunteers.R Re es su ul lt ts s: : OLP and mucosal pressure at all locations increased with cuff volume (all: P < 0.01). Mucosal pressures were highest posteriorly. Mucosal pressures only exceeded 35 cm H 2 O (pharyngeal mucosal perfusion pressure) in the anterior and posterior laryngopharynx and when the cuff volume was > 80-100 mL. Mucosal pressures were similar for cadavers and awake volunteers.C Co on nc cl lu us si io on n: : Mucosal pressures for the LTA increase with cuff volume, are highest posteriorly and potentially exceed mucosal perfusion pressure when cuff volume exceeds 80-100 mL. HE laryngeal tube airway (LTA; VBM Medizintechnik GmbH, Sulz, Germany), first described by Agro et al. 1 in 1999, is a new extraglottic airway device for resuscitation and anesthesia. It consists of an airway tube with a large proximal cuff that inflates in the proximal pharynx to form an airtight seal and a distal conical cuff that inflates in the hypopharynx to prevent regurgitation and gastric insufflation. A single pilot balloon and inflation tubing inflate both cuffs. Early clinical studies suggest that there is a high insertion success rate, 2 positive pressure ventilation is fair to excellent in 88% 1084 CARDIOTHORACIC ANESTHESIA, RESPIRATION AND AIRWAY Objectif : Le tube d'intubation laryngé (TIL) est un nouvel appareil d'intubation extraglottique muni d'un grand ballonnet proximal qui

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Cuffed endotracheal tubes: Mucosal pressures and tracheal wall blood flow

Cited by 87 publications

References 21 publications

Effect of Intra-Cuff Tetracaine on Preventing Postoperative Sore Throat after Gynecological Surgery

Effect of Intra-Cuff Tetracaine on Preventing Postoperative Sore Throat after Gynecological Surgery

Will the Taper Shaped Cuff Replace the Conventional High Volume-Low Pressured Cuff on Endotracheal Tube?

Un ballonnet de grand volume gêne la perfusion de la muqueuse pharyngienne postérieure réalisée avec le tube d’intubation laryngée

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