Post-operative Sore Throat: Comparing the Monitored Endotracheal Tube Cuff Pressure and Pilot Balloon Palpation Methods

Abstract

BackgroundEndotracheal tube cuff (ETTc) inflation pressure is usually not regarded as an important aspect during intubation. In this study, we compared measuring ETTc pressure and pilot balloon palpation method in causing post-operative airway complications.MethodsTwo hundred and ninety-two surgical patients requiring intubation were recruited into this prospective, double-blind, randomised controlled study. Group A patients had their ETTc initially inflated, checked by a cuff pressure gauge, recorded and then set to 25 cmH2O. Group B patients had their ETTc inflated using the pilot balloon palpation method. Patients were then followed up for post-operative sore throat, hoarseness and cough.ResultsThe overall incidence of post-operative sore throat was 39.0% versus 75.3% (P < 0.001), hoarseness 6.2% versus 15.1% (P < 0.05) and cough 7.5% versus 21.9% (P < 0.05) in Group A and B, respectively. Group A patients experienced a significant reduction in the incidence and severity of sore throat up to 24 h post-operatively (P < 0.001), hoarseness at the first hour (P = 0.004) and cough at first and 12 h post-operatively (P = 0.002).ConclusionAdjusting the ETTc pressure to 25 cmH2O reduces post-operative sore throat, hoarseness and cough compared to pilot balloon palpation method.

Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country

“…It was so unreliable that its use in Iranian ICU patients was associated with universal over-inflation of the tracheal cuff, with all being above 40 cmH 2 O (mean 88.8 ± 27.1 cmH 2 O) [ 25 ]. The use of tracheal cuff manometer for objective estimation and monitoring of tracheal cuff pressure reduces postoperative morbidity [ 1 , 26 ]. The very limited use of the manometer in tracheal cuff management in the country cannot be explained away by mere unavailability since other devices for monitoring patients such as the multi-parameter patient monitors are available.…”

“…The cuff also facilitates positive pressure ventilation by forming a good seal with the tracheal mucosa thereby preventing leakage of fresh gas. Over‐inflation of tracheal tube cuff has been associated with postoperative sore throat [ 1 ], tracheal oesophageal fistula [ 2 , 3 ], and tracheal stenosis [ 4 ]. Conversely under-inflation of the tracheal cuff has been implicated with ventilator-associated pneumonia (VAP) [ 5 , 6 ].…”

Anestesisykepleieres metoder for å kontrollere cufftrykk – en observasjonsstudie

“…Endotrakealtuber og larynxmasker blir benyttet ved anestesi og utstyrt med en ballong/ cuff for å tette mellomrommet mellom tube/maske og luftrøret. Studier viser at pasienter i generell anestesi som har fått sine luftveier sikret med endotrakealtube har skader i slimhinner eller opplever hoste, sår hals, heshet eller problemer med å svelge postoperativt (1)(2)(3). De samme skader rapporteres også ved bruk av larynxmasker (4)(5)(6).…”

“…Over halvparten (60 %) av cufftrykkene i endotrakealtubene var utenfor de anbefalte grensene, og 25 % var over okklusjonsgrensen på 50 cmH 2 O med økt risiko for alvorlige komplikasjoner i luftveiene. Dette samsvarer med andre studier som er blitt gjort på cufftrykk i endotrakealtuber (1)(2)(3).…”

Knowledge acquisition and retention among nurses after an educational intervention on endotracheal cuff pressure

“…Although ETT cuff pressure management techniques include the predetermined volume technique, palpation technique, syringe technique, and minimal occlusive volume technique, the gauge manometer is the most reliable manual measurement and is widely recommended 5,6,19 (Siamdous et al, 2015AQ4). However, a gauge manometer is not routinely used in actual practice in some ICUs, 19 and previous studies highlighted that the subjective practice of estimation using finger palpation still exists among practitioners, for example, in Pakistan, 14 Sri Lanka, 5 Egypt (Khalil et al, 2018), Malaysia, 20 Italy, 21,22 India, 23 South Africa, 24 and the United States, 6 among others. An observational cross‐sectional study in Melbourne, Australia, which assessed the minimal leak test and cuff manometer techniques, noted that the minimal leak test results in a cuff pressure outside the recommended range; thus, the authors suggested the use of the cuff manometer technique for reliable practice 25 …”