The Effect of Transesophageal Echocardiography Probe Insertion in Endotracheal Tube Cuff Pressure in Adult Cardiac Surgical Patients.

Abstract

Background and Aims: Insertion of transesophageal echocardiography probe in cardiac surgical patient is a routine practice for surgical planning and decision making. However it may increase the endotracheal tube cuff pressure as it lies adjacent to the posterior wall of trachea. The aim of this study is to evaluate the changes in cuff pressure after insertion of the transesophageal echocardiography probe and after completion of initial manipulation of the transesophageal echocardiography probe during various examinations in adult cardiac surgical patients.
 Methods: Thirty six patients undergoing elective cardiac surgery requiring Transesophageal Echocardiography (TEE) monitoring were enrolled in the study. After induction of general anesthesia and endotracheal intubation cuff pressure were measured at 3 points of time; just after intubation (T1), after transesophageal probe insertion (T2) and after initial completion of TEE study (T3). The mean increase in cuff pressure at various point of time were compared.
 Results: The cuff pressure (mean±SD) at T1, T2 and T3 were 24.61±2.72, 30.22±5.61 and 32.25±4.45 cm of H2O respectively.The cuff pressure increased significantly from T1 to T2 (p<0.001) and from T1 to T3 (p<0.001). The cuff pressure was > 30 cm of H2O in 18 (50%) of patients at T3 which was readjusted back to 25-30 cm of H2O by with drawing air from the cuff.
 Conclusion: Endotracheal tube cuff pressure should be routinely monitored either intermittently or continuously after transesophageal echocardiography probe insertion till it is in situ and pressure should be readjusted to avoid unwanted complications.

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

“…Of the remaining 24 records assessed with a full-text review, 14 were excluded because of the informal nature of publication (i.e., Research Square) (n = 3), conference abstract (n = 4), and irrelevance (n = 7). Finally, a total of ten studies were included in the present meta-analysis 24 – 31 , 40 , 41 .

Figure 1 Summary of the process of study selection for the current meta-analysis.

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“…Ten studies involving 468 participants published between 2011 and 2022 were analyzed 24 – 31 , 40 , 41 . Characteristics of the studies including patient demographics, surgical setting, type of esophageal devices, and size of ETTs are described in Table 1 .…”

“…Focusing on the impact of age on cuff pressure, we divided the results of another report on changes in cuff pressure based on the age of the participants 31 into five studies (i.e., Pan 2020a; Pan 2020b; Pan 2020c; Pan 2020d; Pan 2020e). Of the ten studies, nine observational studies compared the changes in cuff pressure before and after EDI 24 – 29 , 31 , 40 , 41 and one was a randomized controlled trial 30 .…”

“…Regarding the association of EDI with adverse effects, only airway complications were mentioned in the included studies. Eight studies reported no EDI-related complications (e.g., air leak or changes in ventilator parameters) after EDI 24 – 28 , 31 , 40 , 41 , while one study did not provide relevant information 29 . The other study reported an increased severity of sore throat in patients with EDI compared to those without at postoperative 30 min, 2 h, and 24 h 30 .…”

“…Seven studies were available for the analysis 24 , 26 – 28 , 31 , 41 , 42 . A forest plot revealed a high risk of high cuff pressure following EDI (RR = 12.82, 95% CI 4.9 to 33.52, p < 0.00001; I 2 = 47%) (Fig.…”