Evaluation of tracheal cuff pressure variation in spontaneously breathing patients

Abstract

Background:Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation.Objective:To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center.Materials and Methods:Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry.Results:In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings.Conclusion:The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently.

Slaugytojų žinios apie tracheostomos vamzdelio manžetės priežiūrą prieš ir po mokymo

“…Atlikti tyrimai rodo, kad išpučiant manžetę švirkštu, o slėgį nustatant čiuopant pirštais balionėlį, tik trečdalyje atvejų manžetės slėgis buvo rekomenduojamos normos ribose [12]. Todėl manžetės slėgį rekomenduojama matuoti specialiu manometru [10,12,13]. Plotnikow G.A., Roux N., Feld W. ir kt.…”

“…(2013) rekomenduoja manžetės slė-gio matavimus spontaniškai kvėpuojantiems pacientams atlikti dažniau nei kas keturias val. [13]. Kai kurie autoriai nurodo, kad pacientų saugumui užtikrinti būtų galima manžetės slėgį monitoruoti ir stebėti pastoviai specialaus prietaiso pagalba [14], tačiau nepavyko rasti duomenų, kad Lietuvoje manžetės slėgis būtų monitoruojamas ir stebimas nuolat.…”

Changes in the cuff pressure in neonates in the absence of nitrous oxide

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The cuff pressure in tracheal tubes (TTs) should be as low as clinically acceptable to minimize the risk of TT-related airway complications. Several factors are known to affect the cuff pressure of TTs including the duration of anaesthesia, core temperature, neuromuscular blockade, sedation, altitude, the presence of nitrous oxide, tracheal muscle tone and respiratory system impedance, head and neck positions, mechanical ventilation and transoesophageal echocardiography probe insertion [1][2][3][4][5][6][7][8][9][10].Some clinicians avoid the use of nitrous oxide (N 2 O) during surgery because of the theoretical risk of deleterious effects on the neurologic, cardiovascular, hematologic and immune systems [11]. In addition, N 2 O diffuses into air-filled cavities increasing

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“…The cuff pressure in tracheal tubes (TTs) should be as low as clinically acceptable to minimize the risk of TT-related airway complications. Several factors are known to affect the cuff pressure of TTs including the duration of anaesthesia, core temperature, neuromuscular blockade, sedation, altitude, the presence of nitrous oxide, tracheal muscle tone and respiratory system impedance, head and neck positions, mechanical ventilation and transoesophageal echocardiography probe insertion [1][2][3][4][5][6][7][8][9][10].…”