Impact of Endotracheal Tube Cuff Pressure on Postoperative Sore Throat: A Systematic Review and Meta-Analysis

Hu, Baoji; Xu, Jian; Zhao, Xiaohong; Zhang, Nannan; Pan, Meng-Zhi; Bo, Lulong; Duan, Hongwei

doi:10.24015/japm.2016.0022

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…They found that the method to guide cuff inflation was strongly correlated to cuff pressure. These results were similar to previously published studies by Liu J et al (11) and Hu et al (12) , in which they reported that proper control of cuff pressures, reduced postprocedural respiratory complications.…”

Section: Discussionsupporting

confidence: 93%

Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

Narayan¹,

Dhanasekaran²,

Krishnasamy³

2019

JARSS

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Objective: Several methods of endotracheal cuff (ETT) inflation methods were investigated to ensure proper cuff inflation to avoid short, and long term airway morbidities. Pressure Volume Loop (PV-L) closure was found to be a new technique to guide ETT cuff inflation with a lower cuff pressures. Hence, we assessed whether PV-L was a useful guide in inflating the ETT with adequate cuff pressure when compared to Just to Seal (JS) technique. Method: A prospective randomized double-blinded study was done with eighty-four patients undergoing surgeries under general anesthesia using endotracheal tubes. The ETT cuffs were inflated using PV-L closure in PV-L group and using stethoscope in JS group. The cuff pressure was measured as the primary outcome of the study. The cuff volume, postoperative sore throat, cough and hoarseness of voice were assessed as secondary outcomes. Results: In our study, PV-L group had statistically significantly lower post-intubation (24.5±4.97 cm of H 2 O in PV-L group, 28.6±6.39 cm of H 2 O in group JS, p-0.002) and pre-extubation cuff pressures (24.9±4.923 cm of H 2 O in Group PV-L, 29.0±5.624 cm of H 2 O in Group JS, p-0.001) when compared with the JS method. Conclusion: Pressure Volume Loop-guided endotracheal tube cuff inflation was an effective way to seal the airway with lower cuff pressures and was associated with a lower incidence of postoperative ETT cuff-related complications when compared with Just to Seal method. ÖZ Amaç: Kısa ve uzun vadeli hava yolu morbiditelerini önlemek için uygun kaf inflasyonunu sağlayacak pek çok endotrakeal kaf (ETT) şişirme yöntemi incelenmiştir. Basınç Hacim Halkası (BH-H) kapanması, daha düşük kaf basınçları ile ETT kaf inflasyonuna kılavuzluk eden yeni bir teknik olarak bulunmuştur. Bu nedenle, BH-H'nın, hava geçirmeyecek kadar (HGK) tekniği ile karşılaştırıldığında ETT'nin yeterli kaf basıncı ile şişirilmesinde yararlı bir rehber olup olmadığını değerlendirdik. Yöntem: Endotrakeal tüp ile uygulanan genel anestezi altında ameliyat edilen seksen dört hastaya prospektif randomize çift kör bir çalışma yapıldı. ETT kafları, BH-H grubunda BH-H kapanması kullanılarak ve HGK grubunda stetoskop kullanılarak şişirildi. Kaf basıncı, çalışmanın birincil sonucu olarak ölçüldü. Kaf hacmi, postoperatif boğaz ağrısı, öksürük ve ses kısıklığı ikincil sonuçlar olarak değerlendirildi. Bulgular: Çalışmamızda, BH-H grubunda, HGK yöntemi ile karşılaştırıldığında, entübasyon sonrası kaf basıncı (BH-H grubunda 24.5±4.97 cm H 2 O, HGK grubunda 28.6±6.39 cm H 2 O, p-0.002) ve ekstübasyon öncesi kaf basıncı (BH-H grubunda 24.9±4.923 cm H 2 O, HGK grubunda 29.0±5.624 cm H 2 O, p -0.001) istatistiksel olarak anlamlı derecede düşüktü. Sonuç: Endotrakeal tüp kafının Basınç Hacim Halkası rehberliğinde şişirilmesi, hava geçirmeyecek kadar yöntemi ile karşılaştırıldığında, hava yolunu daha düşük kaf basınçları ile kapatmanın etkili bir yoluydu ve daha düşük postoperatif ETT kaf ilişkili komplikasyon sıklığına sahipti.Anahtar kelimeler: Basınç hacim halkası, endotrakeal kaf basıncı, p...

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Section: Discussionsupporting

confidence: 93%

Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

Narayan¹,

Dhanasekaran²,

Krishnasamy³

2019

JARSS

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“…In humans, the incidence of sore throat is commonly cited as a consequence of tracheal mucosal injury secondary to an overinflated cuff. 2,26,27 It is likely that veterinary patients also experience a sore throat after being intubated with an overinflated cuff, but it is very difficult to ascertain. Cats have been reported to have very low incidences of both gastro-oesophageal reflux and even lower, or no, incidence of regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator

White

Makara

Martínez-Taboada

2019

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to compare four inflation techniques on endotracheal tube cuff (ETC) pressure using a feline airway simulator. Methods Ten participants used four different endotracheal cuff inflation techniques to inflate the cuff of a low-pressure, high-volume endotracheal tube within a feline airway simulator. The simulator replicated an average-sized feline trachea, intubated with a 4.5 mm endotracheal tube, connected to a circle breathing system and pressure-controlled ventilation with oxygen and medical air. Participants inflated the ETC: by pilot balloon palpation (P); by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during mechanical ventilation; until a passive release of pressure with use of a loss-of-resistance syringe (LOR); and with use of a syringe with a digital pressure reader (D) specifically designed for endotracheal cuff inflation. Intracuff pressure was measured by a manometer obscured to participants. The ideal pressure was considered to be between 20 and 30 cmH2O. Data were analysed by Shapiro–Wilk, Kruskal–Wallis and χ2 tests, as appropriate. Results Participants were eight veterinarians and two veterinary nurses with additional training in anaesthesia. Measured median intracuff pressures for P, MOV, LOR and D, respectively, were 25 cmH2O (range 4–74 cmH2O), 41 cmH2O (range 4–70 cmH2O), 31 cmH2O (range 18–64 cmH2O) and 22 cmH2O (range 20–30 cmH2O). D performed significantly better ( P <0.001) than all other techniques, with no difference between the other techniques. Conclusions and relevance Use of D for cuff inflation achieved optimal cuff pressures. There may be high operator-dependent variability in the cuff pressures achieved with the use of P, MOV or LOR inflation techniques. As such, a cuff manometer is recommended when using any of these techniques.

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“…[22] Studies have shown that cuff inflation by a manometer is the best means of achieving ideal cuff inflation pressures. [14] We undertook actions taken, and the findings of the QIP were disseminated by email to all the Anesthesia Staff members. All faculty members are now encouraged to use a cuff manometer when inflating the ETT cuff and pass the education material to trainees and anesthesia technicians involved in the clinical service.…”

Section: Discussionmentioning

confidence: 99%

“…However, this has not been confirmed in many studies. [2,14] Concerning ETT size and POST, a systematic review and meta-analysis of three randomized controlled trials (with 509 patients) revealed that the ETT diameter of 6 mm significantly decreased the incidence of POST in the postanesthesia care unit (PACU) compared to ETT size 7 mm. [2] In connection with demographic variables, women are almost twice more likely to suffer from POST after endotracheal intubation than men.…”

Section: Introductionmentioning

confidence: 99%

Effect of Endotracheal Tube Size and Cuff Pressure on Incidence of Postoperative Sore Throat: Comparison between Three Facilities

Hammad¹

2019

Laparosc Endosc Surg Sci

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It is assumed that lower endotracheal tube (ETT) cuff pressure is associated with a lower incidence of postoperative sore throat. However, this is not confirmed in many studies. The relation between ETT size and cuff pressure and the incidence of postoperative sore throat were studied in three different facilities. Methods: Three facilities at Hamad Medical Corporation, Qatar, Tertiary care hospital/ two secondary care hospitals (2ry (1) and 2ry (2)) were addressed in this study. ETT cuff pressure and size were measured by blinded observer after induction of general anesthesia and patients' intubation before the surgery. The sore throat was recorded after full recovery of the patients and before discharge from PACU by a blinded observer. Statistical analysis was performed using Chi-square for comparing between two categorical variables, Pearson Correlation for parametric variables were used to correlate tube size to cuff pressure. Spearman's for non-parametric variables was used to correlate throat pain to changes in cuff pressure and tube size (Sig. is p<0.05). Results: The sore throat was not significantly correlated to either tube size or cuff pressure in the three facilities. Only at 2ry (1), the tube size was significantly correlated to cuff pressure, probably more standardized work. Conclusion: A large number of trainees at tertiary care hospitals may explain the increased incidence of postoperative sore throat and not ETT size and/or cuff pressure.

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Impact of Endotracheal Tube Cuff Pressure on Postoperative Sore Throat: A Systematic Review and Meta-Analysis

Cited by 5 publications

References 17 publications

Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator

Effect of Endotracheal Tube Size and Cuff Pressure on Incidence of Postoperative Sore Throat: Comparison between Three Facilities

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