Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

Abstract

Background The incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation. Methods One hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed. Results Compared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E). Conclusions Compared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness. Trial registration Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Antimicrobial Susceptibility Patterns of of Tracheal Tube Isolates From Patients of Ventilator Associated Pneumonia (Vap) Admitted to the Icu of a Tertiary Care Hospital in Rawalpindi Pakistan

“…The invading microbes move along the airflow and gravity to contaminate the distal airways. Factors including impaired cough reflex, compromised muco-ciliary clearance and damaged tracheal epithelium, create favourable circumstances for bacterial invasion and formation of biofilms on the ETT surface (5) Furthermore, the insertion of ETT often produces ijury and implanation of exogenous and endogenous bacterial inoculum in the tracheal mucosa. It provides an adhering surface to the microorganisms and serves as a reservoir forming a biofilm (6).…”