Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

Negro, Maíra Soliani Del; Barreto, Gilmar; Antonelli, Raíssa Quaiatti; Baldasso, Tiago Antônio; Meirelles, Luciana Rodrigues de; Moreira, Marcos Mello; Tincani, Álfio José

doi:10.5935/1678-9741.20140096

Cited by 5 publications

(6 citation statements)

References 30 publications

(48 reference statements)

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“…If, on one hand, the aforementioned device was enough to prevent the installation of hypoxemia in this model, it should be noted that the effects arising from a possible sub-pressurization in the system could lead to the entrance of fluids in the intracuff region, a fact which was not proven by the Negro et al [ 3 ] study. Another attenuating element to the likely suction of secretions would be that the referred METT is specifically used in elective surgical procedures, particularly if the intubation time is short.…”

Section: Discussionmentioning

confidence: 84%

Evaluation of the Efficiency of the Atraumatic Endotracheal Tube in the Pulmonary-Gas Exchange: an Experimental Study

Antonelli¹,

Moreira²,

Martins³

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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OBJECTIVEMechanical ventilation is frequently necessary, in which case the use of an endotracheal tube is mandatory. The tube has an inflatable balloon in its distal extremity, whose aim is, among other functions, an efficient arterialization. However, serious injuries in the place of contact of the balloon with the trachea can be frequent. Some studies point out that balloons with permanent pressure may reduce this complication. Nevertheless, air scape, expressed by the inspiratory (IV) and expiratory volume (EV) variation (Δ IV-EV), may occur, possibly leading to hypoxemia. Thus, the goal of this study was to verify the efficiency of a modified endotracheal tube on arterializations compared to the traditional endotracheal tube.METHODSThe modified endotracheal tube presents intermittent insufflation, with three drillings in the internal region of the cuff, allowing for insufflation in the inspiratory phase of the mechanical ventilation. Three animals were used for the control group, with a cuff pressure of 30 cmH2O, and seven pigs had the modified endotracheal tube. Each animal was kept under mechanical ventilation (FIO2=0.21) for 6 hours. Arterial and venous gases were measured every three hours (T0; T3; T6).RESULTSThe gases confirmed the lack of hypoxia between the Groups, with a difference in the ΔIV-EV at T0 (P=0.0486).CONCLUSIONSIn this study, the lack of hypoxia showed the efficiency of the modified endotracheal tube. However, new studies are necessary, particularly in diseased lungs, in order to evaluate the real efficiency of the mentioned device on the pulmonary gas exchange.

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Section: Discussionmentioning

confidence: 84%

Evaluation of the Efficiency of the Atraumatic Endotracheal Tube in the Pulmonary-Gas Exchange: an Experimental Study

Antonelli¹,

Moreira²,

Martins³

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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“…The cuffed ETT provides a seal around the trachea and pharyngeal pack is not done routinely. However, in the recent past, some studies 23,24 have investigated the physical and mechanical aspects of ETT cuffs and found that ETTs showed substantial variation in fluid aspiration, relating to cuff material and design. Variability in performance was attributed to the involutional folds that form in the inflated ETT cuff in a random manner.…”

Section: Discussionmentioning

confidence: 99%

“…24 It has been commented that ETT cuffs are not able to completely seal the trachea to prevent aspiration of oropharyngeal secretions. 23 Hence, it was recommended to take other prevention measures as well. 23 A preexisting pack can appear as a friend by assisting NGT placement while reinforcing the seal of tracheal cuff.…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between conventional blind insertion technique and “throat pack in situ” technique

et al. 2023

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Background: Correct placement of nasogastric tube (NGT) placement often becomes difficult in anesthetized, intubated adult patients due to lack of cooperation from patient and the propensity of the tube to travel the same course of path. Preexisting throat pack is supposed to resist the normal passage of the NGT as per common belief. Only one study has evaluated this in pediatric population and the result is encouraging. Aims and Objectives: Hence, the present study has been carried out in adult population to compare the success rate of correct placement of NGT in anesthetized intubated adult patients with the pharyngeal (throat) pack in its position in comparison with no throat pack. This is to examine the effect of preexisting throat pack whether it assists or resists the normal passage of the NGT. Materials and Methods: One hundred and eighty patients were recruited for this interventional and single-blind study. After induction of anesthesia and intubation, the patients were randomized to receive NGT insertion following either blind insertion of the NGT without a pharyngeal pack (group A, n=90) or receive the NGT placement in the same technique but after placement of a pharyngeal pack. The success rate of correct placement of NGT in the first attempt (primary outcome), the procedure time, and adverse events was recorded. Results: Successful insertion of NGT in first attempt was considerably higher in throat pack in situ group compared to blind insertion without a throat pack 81 (90%) versus 63 (70%), respectively (P=0.001). The procedure time for successful placement of NGT was found comparable between the two groups. Significant decrease in coiling is seen in “throat pack in situ” group compared with blind insertion technique (P=0.003). Conclusion: In view of considerable higher success rate and reduced adverse events, it can be concluded that the pre-existing appropriately placed throat pack can facilitate the placement of NGT instead of putting any hindrance.

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“…Leakage of fluid and subsequent microaspiration has been reported to occur even in controlled situations using appropriate tube sizes (16,20). Hence the requirement for a perfect seal is questionable, particularly when the primary goal of a CTT intervention is to provide immediate oxygen and ventilation before the patient succumbs to hypoxia.…”

Section: Sealing Using the Minimum Occlusive Volume Techniquementioning

confidence: 99%

Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes

Hardjo

Haworth²,

Croton³

et al. 2023

Front. Vet. Sci.

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Cricothyrotomy (CTT) has been recommended for use in the pre-hospital setting for military working dogs and Operational K9s during airway emergencies. Although the CTT can establish a patent airway for spontaneous ventilation, the ability to seal the airway and provide positive pressure ventilation (PPV) using tubes designed for humans has not been determined. Using various CTT tubes placed in cadaver dog airways, this study aimed to determine: (1) Whether the tube cuff could create a functional airway seal with safe intra-cuff pressures; (2) The magnitude of delivered tidal volume (TV) loss during a standard breath to assess the possibility of delivering an adequate tidal volume with a bag-valve device (BVM); (3) The best performing tubes for either test; (4) The reasons behind the findings using observations from upper airway endoscopy, dissection, and measurements. Cadaver dogs of similar weights to MWD and Operational K9 breeds had various CTT tubes placed including three from commercial kits, a standard endotracheal tube, and a tracheostomy tube. The minimum occlusive volume technique was used to inflate the tube cuff and a pressure ≤ 48 cm H2O with an adequate seal was considered successful. Individual TVs were calculated for each dog and added to the volume lost during delivery of a standard breath from an ICU ventilator. Endoscopy and airway dissection were performed to assess the relationship between tubes cuffs and the airway. The tubes from the CTT kits performed poorly with regards to producing an airway seal with the H&H tube failing to seal the airway all tests. Tracheal dimensions were significantly associated with successful airway sealing (P = 0.0004). Tidal volume loss could be compensated using a BVM in 34/35 tests with the H&H tube in cadaver 8 the only to fail. Tracheal airway sealing is influenced by airway anatomy when tube cuffs are inflated to a target pressure and larger tubes do not always provide a better seal. The CTT tubes tested have the potential to facilitate ventilation with a BVM under the conditions set in this study. The 8.0 mm endotracheal tube performed the best and the H&H the worst in both tests.

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Effectiveness of the endotracheal tube cuff on the trachea: physical and mechanical aspects

Cited by 5 publications

References 30 publications

Evaluation of the Efficiency of the Atraumatic Endotracheal Tube in the Pulmonary-Gas Exchange: an Experimental Study

Evaluation of the Efficiency of the Atraumatic Endotracheal Tube in the Pulmonary-Gas Exchange: an Experimental Study

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between conventional blind insertion technique and “throat pack in situ” technique

Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes

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