Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management

Dw, Bolzan; Gomes, Walter J.; Faresin, Sônia Maria; Ac, Carvalho; Aa, de Paola; Guizilini, Solange

doi:10.4187/respcare.01812

Cited by 15 publications

(20 citation statements)

References 18 publications

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“…The volume waveform may be useful to detect the presence of a leak (eg, bronchopleural fistula, leak around the cuff, leak around the mask), which results in a difference between the inspiratory and expiratory V T . Bolzan et al 34 reported a method for managing endotracheal tube cuff inflation using volume-time graphics.…”

Section: Tidal Volumementioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the RESPIRATORY CARE • NOVEMBER 2014 VOL 59 NO 11 1773 setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressuretime curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.

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Section: Tidal Volumementioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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“…We hypothesized that using the volume-time curve technique, which resulted in smaller cuff pressure after airway sealing, 3 could reduce the occurrence of endotracheal intubation-related respiratory symptoms, including sore throat, cough, and thoracic pain, secondary to a cough in patients submitted to coronary artery bypass grafting and a short period of mechanical ventilation, thus influencing the capacities and pulmonary volumes in the early postoperative phase.…”

Section: See the Related Editorial On Page 1810mentioning

confidence: 99%

“…During inflation, the examiner kept his ear 10 cm from the subject's mouth to ensure that there was no air leak. 3 Volume-Time Curve Group (n ‫؍‬ 228). The cuff was fully deflated and gradually inflated with a 20-mL syringe while the examiner analyzed the volume-time curve to generate a proper adjustment of air volume that should be…”

Section: Anesthesia and Operative Techniquementioning

confidence: 99%

“…We performed the inflation until the descending branch of the volume-time curve returned to zero, interrupting the flattening that presented earlier. 3 During the operation, we ventilated the subjects to maintain normocapnia with F IO 2 between 50 and 60% without PEEP. We conducted the on-pump or off-pump coronary artery bypass grafting through a midline sternotomy and the left internal thoracic artery, complemented with additional saphenous vein grafts.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…The MOV technique has been suggested in the literature as the most appropriate technique for promoting adequate cuff inflation, although several studies have indicated that this technique could be inaccurate because it is difficult to determine precisely when to stop inflating the cuff, which can result in cuff overinflation or hyperinflation. [2][3][4][5] In a previous study, 3 we showed that the volume-time curve technique for ETT cuff management can promote lower cuff pressure and a lower volume of air injected into the cuff compared with the MOV technique because of its capability to identify in real time the exact air volume that is required to fill the cuff to prevent air leakage. However, the clinical impact of the volume-time curve technique has not been documented.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

Gomes

et al. 2014

Respir Care

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BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n ‫؍‬ 222) and volume-time curve group (n ‫؍‬ 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: The volume-time curve group presented significantly lower cuff pressure (30.9 ؎ 2.8 vs 37.7 ؎ 3.4 cm H 2 O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ؎ 1.8 vs 7.1 ؎ 1.7), better preservation of FVC (49.5 ؎ 9.9 vs 41.8 ؎ 12.9%, P ‫؍‬ .005), and FEV 1 (46.6 ؎ 1.8 vs 38.6 ؎ 1.4%, P ‫؍‬ .005) compared with the MOV group. CONCLUSIONS: The subjects who received the volumetime curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

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Accuracy of the minimal leak test for endotracheal cuff pressure monitoring

et al. 2019

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Objectives To determine the accuracy of the minimum leak test as a surrogate for target endotracheal cuff pressure of 20–30 cm H2O in intubated patients. Methods Cuff pressures were measured at the University of Miami Hospital using the minimum leak test on every intubated patient once per shift, then cuff pressure was reevaluated using handheld numerical manometers and recorded pressures above or below the target range, readjusting the pressure as needed. This assessment was repeated throughout each patient's intubation for up to 6 days. The readjustment rate of the test and the probability of a patient needing at least one adjustment were determined. Results One hundred twenty‐two patients were evaluated. Median age was 67 years (range 29–95), 52% were male, 48% were female. Patients were followed for an average of 4.7 days. Seven hundred twenty‐two minimum leak tests were performed. Of these, 170 required readjustment into the target range (24% readjustment rate). Of the tests outside target range, 66% of cuffs were overinflated and 34% were underinflated. Fifty‐five percent of patients required at least one adjustment. Conclusion Despite ubiquitous use of the minimum leak test for endotracheal cuff pressure adjustment, the test has an unacceptably high error rate resulting in cuff pressures above or below the target range. Most patients will require at least one adjustment throughout an intubation, putting them at risk for tracheal injury, stenosis, or leak and aspiration. The minimum leak test is not sufficiently accurate for endotracheal cuff pressure monitoring. Formal manometry is superior and should be used to optimize patient outcomes. Level of Evidence 4 Laryngoscope, 130:1646–1650, 2020

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Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management

Cited by 15 publications

References 18 publications

Respiratory Mechanics in Mechanically Ventilated Patients

Respiratory Mechanics in Mechanically Ventilated Patients

Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

Accuracy of the minimal leak test for endotracheal cuff pressure monitoring

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