Cuffed Tubes as a Cause of Tracheal Stenosis

Shelly, Walter M.; Dawson, Rhona; May, Ivan A.

doi:10.1097/00132586-197010000-00017

Cited by 6 publications

(17 citation statements)

References 0 publications

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“…Some of the important factors, in addition to the time factor, are as follows: (a) the general condition of the patient; (b) the material of the tube [1,5]; (c) the size of the tube in relationship to the patient's trachea [2,7,8,10,11]; (d) careful intubatory technique [2,5,10,11]; (e) use of a cuff and the amount of pressure in the cuff [1,11,15]; (f) degree of moisture in the respiratory air both in the period of intubation and the first period after extubation [4,5,7,10,11], and last but not least (g) extremely careful nursing which these often very sick patients demand.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Upper Respiratory Tract after Prolonged Naso-Tracheal Intubation

Bl¹

1972

ORL

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Changes in the upper respiratory tract after naso-tracheal intubation were studied in a group of 95 patients who had been intubated for a prolonged period of time because of respiratory insuffiency. Length of intubation varied from 1 to 31 days. Patients were followed by frequent inspection of the upper respiratory tract until all objective changes had disappeared. Mucosal lesions of the oro- and hypopharynx apparently played only a minor role. In the nasal cavity mucosal necrosis of varying extent and at times even granulation was found, but all changes healed spontaneously. The laryngeal changes also disappeared spontaneously. These changes consisted primarily of deposits on the vocal cords and the posterior subglottis together with erosion of the arytenoid cartilage. In 10% of the cases laryngeal granulation polyps were seen which disappeared spontaneously. After extubation stenosis in the subglottis or trachea was seen in 3 cases and was apparently in part caused by intubation. On the basis of this study it is concluded that changes and late complications after prolonged naso-tracheal intubation are so minor that intubation can be continued for several days without serious risk.

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Section: Discussionmentioning

confidence: 99%

Changes in the Upper Respiratory Tract after Prolonged Naso-Tracheal Intubation

Bl¹

1972

ORL

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“…These complications were increasingly being reported by the late 1960s as mechanical ventilation outside of the operating suite became more prominent. [14][15][16][17] As the high-pressure low-volume cuff became recognized as a problem, it became appreciated that increasing the size of the cuff and stretching the cuff material could result in an adequate seal at lower tracheal pressures. Some clinicians made their own high-volume low-pressure (HVLP) cuff by prestretching the cuff of the PVC tube using boiling water.…”

Section: History and Early Development Of The Endotracheal Tubementioning

confidence: 99%

Endotracheal Tubes: Old and NewDiscussion

et al. 2014

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The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.

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“…Cuff pressure is an important etiologic factor in tracheal stenosis secondary to intubation with cuffed inflatable tracheostomy tubes. Studies have shown a progressive inflammatory response at the areas of maximum irritation from the tracheostomy tube and/or inflatable cuff [3,4,23]. Strictures developing at the level of the cuff are the result of circumferential mucosal ulceration of the trachealmucosal membrane, which result from local ischemic changes due to pressure exerted between the outside of the cuff and the tracheal wall [3,4].…”

Section: Stomal Complicationsmentioning

confidence: 99%

“…Studies have shown a progressive inflammatory response at the areas of maximum irritation from the tracheostomy tube and/or inflatable cuff [3,4,23]. Strictures developing at the level of the cuff are the result of circumferential mucosal ulceration of the trachealmucosal membrane, which result from local ischemic changes due to pressure exerted between the outside of the cuff and the tracheal wall [3,4]. The mucosa at these sites becomes hypoxic and ulcerates to expose the cartilaginous rings [3,4].…”

Section: Stomal Complicationsmentioning

confidence: 99%

“…However, tracheotomy and tracheal stoma intubation present noteworthy hazards and complications. Some of the more common complications include tracheal stenosis secondary to cuffed endotracheal tube inflation [2][3][4][20][21][22], pneumonia [10,14], tracheobronchitis [13,14], tracheitis [11], hemorrhage from innominate artery dissection [9,24], laryngeal trauma including laryngeal nerve damage [14], stoma occlusion [14], stoma closure [12][13][14], and tracheoesophageal fistula [23,24].…”

Section: Introductionmentioning

confidence: 99%

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