Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes

Weiß, Markus; Doell, Carsten; Koepfer, Nelly; Madjdpour, Caveh; Woitzek, K; Bernet, Vera

doi:10.1093/bja/aen355

Cited by 43 publications

(35 citation statements)

References 21 publications

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“…In critically ill patients, contaminated secretions can leak through the tracheal cuff and result in ventilator-associated pneumonia (2,3). High cuff pressure increases the risk for tracheomalacia and tracheal dilation in patients intubated for a long time (4). Cuff manometers are manual or automatic devices that measure the pressure in the endotracheal tube (ETT) or laryngeal mask airway (LMA) cuffs, and some can work to keep pressure at a certain level for a long time.…”

mentioning

confidence: 99%

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Saraçoğlu¹,

Dal²,

Pehlivan³

et al. 2014

Turk J Anesth Reanim

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Objective: Cuffs inflated to inappropriately high pressures cause ischemia, reducing tracheal mucosal blood flow, while cuffs inflated at lower pressure than necessary give rise to inadequate ventilation, aspiration of gastric contents, or extubation due to air leakage. In this study, we aimed to investigate the effect of the experience of anaesthesia staff on endotracheal tube and laryngeal mask airway cuff inflation. Methods:The study included 348 elective patients scheduled to undergo surgery under general anaesthesia, with 34 anaesthesia technicians, 16 anaesthesia residents, and 12 anaesthesiologists with different years of professional experience. The participants were told to inflate the cuff balloon with air to the level of the pressure that was appropriate for them. No information was provided to the participants about the values of the cuff pressure pending the completion of all measurements. After placement of the laryngeal mask airway and endotracheal tube, the success of the procedure was checked by monitoring square-wave capnograph tracing and thoracoabdominal motion. Each participant performed the procedures on three patients, and the mean cuff pressures were measured. Results:There was no significant correlation between duration of experience of technicians, residents, and experts in using laryngeal mask airway pressure (r=-0.192/p=0.278, r=0.225/p=0.402, r=-0.476/p=0.118, respectively) and endotracheal tube (r=-0.306/ p=0.079, r=-0.060/p=0.826, r=-0.478/0.116, respectively). Conclusion:It has been concluded that professional experience does not contribute to achieving normal cuff pressure without monitoring. Introduction of the cuff manometer into routine anaesthesia practice will be useful, irrespective of anaesthesiologists' experience.

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mentioning

confidence: 99%

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Saraçoğlu¹,

Dal²,

Pehlivan³

et al. 2014

Turk J Anesth Reanim

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“…8,11,12 This may be favored by the time constant of the system's response that limits overcompensation (deflation) from occurring when tracheal pressure increases rapidly. 13 Moreover, by design, pneumatic systems limit overcompensation (cuff deflation) in the case of high pressure because regulation is based on a transfer of gas into the system rather than allowing cuff deflation and thus imposing iterative inflation procedures.…”

Section: Tracheal Cuff Management As Part Of a Lung-protective Strategymentioning

confidence: 99%

“…In a bench study, Weiss et al 13 suggested that cuff pressure should ideally follow airway peak inspiratory pressure to ensure sealing around the tracheal tube cuff during Dr Richard has disclosed relationships with Air Liquide Medical Systems, Covidien, Vygon, Dräger, and GE Healthcare. Dr Mercat has disclosed relationships with Covidien, Maquet, and GE Healthcare.…”

Section: Tracheal Cuff Management As Part Of a Lung-protective Strategymentioning

confidence: 99%

“…Experimental studies showed that cuff pressure may vary widely during mechanical ventilation, and the ideal cuff pressure range is difficult to define, depending on tracheal tube size and airway pressure regime. 8,13 A new technological approach to control tracheal tube sealing while limiting cuff pressure should be developed. This is particularly important for prolonged mechanical ventilation and most severely critically ill patients.…”

Section: Tracheal Cuff Management As Part Of a Lung-protective Strategymentioning

confidence: 99%

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Tracheal Cuff Management as Part of a Lung-Protective Strategy

Richard

Mercat

2014

Respir Care

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“…Various tubes, cuffs and pilot balloons have been designed to limit this, with very limited or short-lived efficacy. These include the Portex Profile Soft-seal TM (PSSC; Sims Portex, Kent, UK) [20], Trachelon TM gas barrier (Terumo Co. Ltd., Tokyo, Japan) [21] [17,[26][27][28][29][30][31][32][33][34][35][36][37]. Whilst these devices should, theoretically, help to ensure correct cuff pressure, none have gained widespread adoption into routine clinical practice.…”

mentioning

confidence: 99%

The effect of pilot balloon design on estimation of safe tracheal tube cuff pressure

Janossy

Pullen²,

Young

et al. 2010

Anaesthesia

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SummaryWe studied the effect of pilot balloon design on the ability of experienced anaesthetists to assess and inflate tracheal tube cuffs to safe pressures. A model trachea was designed, incorporating a degree of compliance and an air leak, to evaluate six different pilot balloons grafted onto identical tracheal tubes. Pilot balloons were inflated to one of four pressures and anaesthetists were asked to estimate whether the pressure was acceptable, too low or too high. Anaesthetists were then asked to inflate the cuff of each tube. Overall, 103 (42.9%) of anaesthetists' assessments of tracheal tube cuff pressures were correct (33% correct would be expected by chance, p = 0.002). Pressures generated by anaesthetists inflating tracheal tube cuffs were very variable.

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Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes

Abstract: Automated cuff pressure controllers with rapid pressure correction interfere with the self-sealing mechanism of high sealing HVLP tube cuffs and reduce their improved sealing characteristics.

Cited by 43 publications

References 21 publications

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Tracheal Cuff Management as Part of a Lung-Protective Strategy

The effect of pilot balloon design on estimation of safe tracheal tube cuff pressure

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