Measuring endotracheal tube intracuff pressure: no room for complacency

Kumar, Chandra M.; Seet, Edwin; Zundert, Tom C. R. V. Van

doi:10.1007/s10877-020-00501-2

Cited by 41 publications

(49 citation statements)

References 69 publications

(81 reference statements)

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“…This is a dynamic process, and frequent adjustments may be indicated depending on ventilation parameters. Prevention of tracheal mucosal pressure necrosis, resulting tracheal and cricoid chondritis and subsequent stenosis is critical in the SARS‐CoV‐2 population 25,26 …”

Section: Recommendationsmentioning

confidence: 99%

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

et al. 2020

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The rapid spread of SARS-CoV-2 in 2019 and 2020 has resulted in a worldwide pandemic characterized by severe pulmonary inflammation, effusions, and rapid respiratory compromise. The result of this pandemic is a large and increasing number of patients requiring endotracheal intubation and prolonged ventilator support. The rapid rise in endotracheal intubations coupled with prolonged ventilation requirements will certainly lead to an increase in tracheostomy procedures in the coming weeks and months. Performing tracheostomy in the setting of active SARS-CoV-2, when necessary, poses a unique situation, with unique risks and benefits for both the patient and the health care providers. The New York Head and Neck Society has collaborated on this document to provide guidance on the performance of tracheostomies during the SARS-CoV-2 pandemic.

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Section: Recommendationsmentioning

confidence: 99%

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

et al. 2020

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“…The closer the inflation volume was to the corrected target value, the closer the actual measured value was to the corrected target value, and the measurement was more accurate. Analysis of the reasons may be related to the application of HVLP cuffs, when the gas capacity in the cuff changes greatly, the pressure change of the cuff is smaller to ensure the safety of the cuff because of the large contact area between the cuff and the tracheal wall clinically [19]. Therefore, in order to improve the accuracy of the measurement, it is advisable to use the modified cuff pressure measurement method to measure.…”

Section: Discussionmentioning

confidence: 99%

The effect of different inflating volume on the measurement accuracy of the modified cuff pressure measurement method

Xiang

Cao

Song

et al. 2021

J Clin Monit Comput

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To evaluate the effect of different inflation volume on the measurement accuracy of the modified cuff pressure measurement method in different shapes of cuffs, so as to provide reference for the correct monitoring of cuff pressure in clinic. In vitro study: The traditional cuff pressure measurement method (the cuff pressure gauge before measurement shows 0 cm H 2 O) and the modified cuff pressure measurement method (the cuff pressure before measurement shows 25 cm H 2 O, 28 cm H 2 O, 30 cm H 2 O or 32 cm H 2 O) were used to measure cylindrical and tapered cuffs, and the effect of different inflation volume on cuff pressure was analyzed statistically. Clinical study: patients with the artificial airway established by orotracheal intubation or tracheotomy in Neuro-ICU were prospectively selected as subjects, and the measurement procedure was the same as in vitro study. In vitro study showed that the pressure loss values of cylindrical cuff and tapered cuff using the traditional cuff pressure measurement method were (3.75 ± 0.31) cm H 2 O and (4.92 ± 0.44) cm H 2 O, respectively, and clinical study showed that the pressure loss values were (5.07 ± 0.83) cm H 2 O and (5.17 ± 0.93) cm H 2 O, respectively. The actual measured values measured by the traditional cuff pressure measurement method of the two cuff shapes were compared with the corrected target value of 28 cm H 2 O, and the differences were statistically significant (P < 0.000). Both in vitro and clinical study had shown that all differences between the actual measured value and the corrected target value using the modified cuff pressure measurement method (measured with 25 cm H 2 O, 30 cm H 2 O, 32 cm H 2 O) were statistically significant (P < 0.000), and the range of overall differences was (0-1.23 ± 0.25) cm H 2 O. In vitro study had shown that the pressure variation coefficient (CV) of the tapered cuff was greater than that of the cylindrical cuff, and the difference was statistically significant (3.08 ± 0.25 VS 2.41 ± 0.21, P < 0.000). The traditional cuff pressure measurement method can directly lead to the cuff pressure drop, which is easy to cause the leakage of secretions on the cuffs and the misjudgment of the cuff pressure by medical personnel. However, the modified cuff pressure measurement method can effectively reduce cuff pressure loss, and taking the actual cuff pressure value as the inflation volume is the highest measurement accuracy.The tapered cuff is more susceptible to air volume, so it is necessary to pay attention to its measurement and correction in clinical practice.

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“…Postoperative airway complications included airway stenosis symptoms and airway infection [ 1 ]. Airway stenosis symptoms were defined as subjective findings, such as difficulty in breathing, and objective findings, such as stenotic sounds and tracheal edema confirmed using bronchoscopy.…”

Section: Case Presentationmentioning

confidence: 99%

“…A cuff pressure of 30 cmH 2 O or higher that may block blood flow in the tracheal mucosa [ 1 , 4 ] was observed in all cases. The optimal cuff pressure exceeded approximately 40% of the operation time.…”

Section: Case Presentationmentioning

confidence: 99%

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Examination of the frequency of upward and downward fluctuations in the pressure obtained from the cuff pressure-time curve by continuous measurement of endotracheal tube cuff pressure during thyroid surgery: a case series

2021

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Background Few studies examined time-to-time changes of cuff pressure of an endotracheal tube during surgery. We retrospectively analyzed the changes of cuff pressure during thyroid surgery and examined its relationships with postoperative airway complications. Case presentation Cuff pressure was initially adjusted at 26 cmH2O and continuously measured in 61 patients. The cuff pressure-time curve dynamically fluctuated, and exceeded 30 cmH2O in all patients, whereas decreased to ≤ 20 cmH20 in 42 (69%) patients. Ratio of the period with such an increase and decrease of cuff pressure to the total duration of surgery were 40% (28–66%) and 9% (0–21%), respectively (median, interquartile range). No patients showed symptoms of airway stenosis requiring treatment except one who developed recurrent laryngeal nerve palsy. No patients had lower respiratory tract infection. Conclusions Cuff pressure dynamically fluctuated during thyroid surgery. Preventing an increase as well as decrease of cuff pressure is required.

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Measuring endotracheal tube intracuff pressure: no room for complacency

Cited by 41 publications

References 69 publications

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

The effect of different inflating volume on the measurement accuracy of the modified cuff pressure measurement method

Examination of the frequency of upward and downward fluctuations in the pressure obtained from the cuff pressure-time curve by continuous measurement of endotracheal tube cuff pressure during thyroid surgery: a case series

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