Tracheal Pathology Following Short-Term Intubation with Low-and High-Pressure Endotracheal Tube Cuffs

Abstract

Histologic sections of dog tracheas were taken from 20 dogs anesthetized and intubated for 5 to 7 hours with high-pressure, low-volume Shiley or low-pressure, high-volume Lanz endo-tracheal tubes. Microscopic examination and measurement showed that while the high-pressure, low-volume cuff produced deeper average mucosal erosion, the large-volume, low-pressure cuff resulted in significantly greater lengths of tracheal mucosa-cuff erosion. Maximal depth of penetration throught the basement membrane was similar in both groups. Grooves in the mucosa were seen in 50% of the high-volume-cuff trachea sections but none of the low-volume-cuff tracheal sections. These findings demonstrate that low-pressure, high-volume endotracheal tube cuffs produce different but significant tracheal damage after short-term intubation when compared to high-pressure, low-volume cuffs.

Topical application of corticosteroids to tracheal tubes to prevent postoperative sore throat in adults undergoing tracheal intubation: a systematic review and meta‐analysis

“…Proposed causes of postoperative sore throat include: mucosal erosion by the tracheal tube cuffs ; mechanical trauma from intubation; and inflammation of the mucosa . Studies have suggested that various anti‐inflammatory and analgesic agents, such as inhaled corticosteroids , systemic corticosteroids , ketamine gargle , liquorice gargle , and topical benzydamine hydrochloride , could prevent postoperative sore throat.…”

Clinical Analysis of Laryngeal Trauma Secondary to Intubation

“…Reviews of the more common complications have been published, as also have comparisons of morbidity rates with various techniques and materials (Baron & Kohlmoos 1951, Blanc & Tremblay 1974, Bryce et al 1968, Kambic & Radsel 1978, McGovern et al 1971. Histological analyses of the lesions produced by intubation have been made with accuracy both quantitatively and qualitatively (Burns et al 1970, Hilding 1971, Loeser et al 1978. The respiratory function of the larynx and trachea is the sole physiological activity to have undergone similar scrutiny following intubation (Stewart et al 1980, Strong & Passy 1977.…”

CO2 driven endotracheal tube cuff control in critically ill patients: A randomized controlled study

“…During last decades, the wide distribution of high-volume low-pressure (Hi-Lo) ETTs, helping to avoid ETT cuff overinflation, has significantly reduced the frequency of ischemic tracheal lesions[19]. However, in a randomized controlled animal study where the efficacy of a pneumatic device for P cuff management was tested, no differences were identified in the prevalence of tracheal mucosa lesions between the two animal groups[20].…”