Cuffed tubes as a cause of tracheal stenosis

Shelly, Walter M.; Dawson, Richard B.; May, Ivan A.

doi:10.1016/s0022-5223(19)42674-3

Cited by 54 publications

(3 citation statements)

References 9 publications

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“…An der Entstehung der Trachealstenosen nach einer Tracheotomie beteiligt sich eine Reihe von Faktoren, wie Operationstechnik, Druck der Blockermanschette an der Trachealkanüle, Fertigungsmaterial der Kanüle, lokale Infektionen, Allgemeinzustand der Patienten usw. (13,7,3,10).…”

Section: Chodounskd V Snajdr a Tomänek F Fiserunclassified

Chirurgische Behandlung der Trachealstenose

Chodounská¹,

Šnajdr²,

Tomanek³

et al. 1972

Thorac cardiovasc Surg

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Section: Chodounskd V Snajdr a Tomänek F Fiserunclassified

Chirurgische Behandlung der Trachealstenose

Chodounská¹,

Šnajdr²,

Tomanek³

et al. 1972

Thorac cardiovasc Surg

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“…Keeping the cuff inflated for long time can result in ischemia of tracheal mucosa and further complications such as postoperative sore throat [1] , hoarseness of voice, tracheal ulceration, stenosis, trachea oesophageal fistula etc [2] . N20, an anaesthetic gas commonly used in conjunction with oxygen and other volatile anaesthetic agents is known to diffuse into air filled cavities including ETT cuffs leading to an increase in cuff pressure [3] [6] , which is transmitted to the tracheal mucosa and can cause serious sequelae. A study of blood flow in rabbit tracheal mucosa demonstrated that when a high-pressure low volume cuff pressure was inflated to >30 mm Hg, the mucosa in contact with the cuff, i.e., that covering the tracheal cartilage, become ischemic [4] .…”

Section: Introductionmentioning

confidence: 99%

Changes in endotracheal tube cuff pressures and incidence of post-operative sore throat while using different inflating agents

Aziz,

Zafor,

Nimmi

et al. 2024

J. Bangladesh Coll. Phys.

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Background & Aims: Post-operative sore throat is one of the minor complications after general anaesthesia with endo tracheal intubation. Although short lasting and self-limiting, it creates an uncomfortable situation for patient. Diffusion of Nitrous Oxide (N20) into endotracheal tube (ETT) cuffs and increase intra cuff pressure causes this. Different inflating agents have been studied to see the incidence of intra cuff pressure changes. This study was performed to see the post extubation tracheal mucosal changes and post-operative sore throat after using N20 in Oxygen as ETT cuff with direct visualization of the tracheal mucosa just after tracheal extubation. Methods: Institutional ethical committee approval and informed written consent were obtained, 50 patients, undergoing elective surgery under general anaesthesia, were enrolled. Patients were randomly allocated in two groups of 25. In Group A, the ETT cuff was inflated with air, in Group B, cuff was inflated with 67% N₂0 in oxygen. The cuff pressure was kept around 30 cm H₂0 and was measured every 10 minutes. The condition of the trachea was seen using fibreoptic bronchoscope and a grading was done. All the data was collected & statistical analysis performed. Results: The frequencies of pain, difficulty in swallowing, and hoarseness of voice at the recovery room within the first two hours after anaesthesia were lowest in Group B than Group A and significantly reduced within 24 hours. Perioperatively cuff pressure change in group A was significantly high and in group B it was minimum. Bronchoscopic view of larynx and trachea showed 64 % normal. 22% was erythematous, 10% was oedematous in group B. In group A it was 28%, 46% and 24%. Conclusions: It is evident, that N₂0 in 0₂ filled ETT cuff reduces the incidence of postoperative sore throat. It is proposed that the difference was produced due to no or minimum diffusion of N₂0 in N₂0 with 0₂ filled ETT cuff, subsequently no significant intra cuff pressure changes per operatively. J Bangladesh Coll Phys Surg 2024; 42: 12-18

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“…High-compliance endotracheal tubes are mainly used for sealing the airway to prevent pulmonary aspiration [2]. Although cuffs need to be loaded with pressures high enough to prevent the loss of tidal volume and aspiration into the trachea, problems caused by excessive cuff pressures also need to be considered [3][4][5][6][7]. The main issues after consistently high cuff pressures are decreased tracheal capillary perfusion, direct tracheal wall injury leading to loss of mucosal cilia, ulceration, bleeding, and even tracheoesophageal fistulas in severe cases [5,8].…”

Section: Introductionmentioning

confidence: 99%

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

et al. 2020

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Objective This study aimed to determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy.Methods We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer.Results For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH<sub>2</sub>O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH<sub>2</sub>O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types.Conclusion Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

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Cuffed tubes as a cause of tracheal stenosis

Cited by 54 publications

References 9 publications

Chirurgische Behandlung der Trachealstenose

Chirurgische Behandlung der Trachealstenose

Changes in endotracheal tube cuff pressures and incidence of post-operative sore throat while using different inflating agents

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

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