Subglottic perioperative airway—tube inflation via randomized evaluation with variable syringe size (Spair‐Tire) study

Abstract

Introduction Risks of endotracheal tube cuff (ETTC) over inflation must be balanced with the need to achieve a minimum pressure of 20 cm H2O. Methods have been developed to estimate adequate ETTC pressurization but do not provide accurate endotracheal tube cuff pressure (ETCP) measurements. Hence, different sized syringes may play a role in determining ETCP. Objectives Determine optimal syringe size for recommended ETCP. Methods Two hundred patients were randomized to use of either a 10‐mL syringe (standard syringe) or a 5‐mL syringe (study group) for ETTC inflation. Following the insertion of the endotracheal tube, the ETTC was inflated per the attending anesthesiologist. Within 10 minutes of intubation, ETCP was measured with a hospital‐provided manometer. Results The percentage of in range cuff pressures for the 5‐mL group was 10.53% and 6.78% for the 10‐mL group. 84.21% (n = 64) of the study group and 91.53% (n = 54) of the control group had cuff pressures exceeding 30 cmH2O. Although our study did not demonstrate that syringe size was predictive of ideal cuff pressure ranges, the average cuff pressure for the 5‐mL group was 55.8 cm H2O versus 68.8 cm H2O in the 10‐mL group. Conclusion Although both 5‐ and 10‐mL syringes resulted in elevated cuff pressures after intubation, 5‐mL syringes resulted in a lower degree of elevation. Use of a 5‐mL syringe should be considered when inflating the endotracheal cuff to possibly reduce patient harm secondary to elevated cuff pressures. Further studies assessing smaller syringe sizes to reduce cuff pressures are warranted.

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study

“…Distinct strategies, using subjective and objective methods, have been proposed to attain adequate control of the cuff pressure and reduce the risks of complications. 11 , 12 , 13 , 14 , 15 , 16 , 17 However, evidence adds up against using subjective methods, and also signals toward a non-correlation between measured cuff pressure and age, sex, height and weight of patients. Additionally, pressures measured do not differ as a function of tracheal tube size or of the expertise of the professional executing the procedure.…”