The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head

Abstract

BackgroundThe proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement.MethodsFifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively.ResultsThere were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 ± 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 ± 6.7 (P < 0.001) and 26.7 ± 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 ± 8.8 (P < 0.001) and 29.9 ± 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure.ConclusionsThe position change from supine to prone without head movement can cause a change in ETT cuff pressure.

Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position

“…[11][12][13][14][15][16][17] Head extension can result in cephalad migration of the ETT, whereas head flexion can result in caudal displacement. 12,18 Lateral rotation of the head can cause movement of the ETT tip in both directions. 12 In this study, alterations in head position, such as extension and/or rotation, may be responsible in part for ETT tip migration from the carina after the change to the lateral flank position.…”

“…[7][8][9][10] Positional change and neck movement after intubation can displace an ETT in a patient's trachea. [11][12][13][14][15][16][17][18] Intratracheal migration of the ETT due to a change in patient positioning can result in a change in the ETT cuff pressure because the trachea is not cylindrical. [19][20][21][22] When the ETT migrates proximally toward the vocal cords, the cuff shape may be distorted and the intracuff volume may be compressed at a narrower and less compliant upper airway space such as at the level of the cricoid cartilage.…”

Evaluation of Endotracheal Tube Cuff Pressure and the Use of Three Cuff Inflation Syringe Devices in Dogs

“…In human patients, it was found that the ETT cuff pressure increased after changing the body position from supine to prone (32). The explanations for such changes included the compression of the trachea and ETT cuff by the spine, muscles and major vessels, and the increased intra-thoracic pressure in prone position due to the compression of the anterior chest wall and the abdomen (32). Further studies with a larger number of observations may help to elucidate the correlation between the body position changes and the ETT cuff pressure changes in dogs.…”

Hıgh Intraoperatıve Cuff Pressure Incıdence Due to Endotracheal Cuff Inflatıon Methods And Its Clınıcal Effects

“…Endotrakeal kaf inflasyon yöntemi olarak pilot balon palpasyonu ve direnç kaybı yöntemi kullanılan bir çalışmada, ses kısıklığı sıklığı %9 olarak bildirilmiştir (18) Kim ve ark. (20) , baş pozisyonunun değiştirilmesiyle kaf basınçlarının değiştiğini göstermiştir. Çalışmalarında, başın nötral pozisyondan fleksiyona ve hastaların supin pozisyondan pron pozisyona çevirilmesiyle kaf basınçlarında değişiklik saptamışlar.…”