DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200227

Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

Mamta Bhardwaj, Kiranpreet Kaur, Asha Sharma, Prashant Kumar, Raj Tobria, Savita Saini

Abstract


Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.

Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.

Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.

Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.


Keywords


Cuff pressure, Endotracheal tube, Just seal, Pressure volume loop, Stethoscope guided

Full Text:

PDF

References


Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol. 2004;4(1):8.

Striebel HW, Pinkwart LU, Karavias T. Tracheal rupture caused by overinflation of endotracheal tube cuff. Der Anaesthesist. 1995;44(3):186-8.

Luna CM, Legarreta GI, Esteva H, Laffaire E, Jolly EC. Effect of tracheal dilatation and rupture on mechanical ventilation using a low-pressure cuff tube. Chest. 1993;104(2):639-40.

Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest surg clin North Am. 2003;13(2):271-89.

Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery-Manual vs. automatic method. J Anaesthesiol, Clin Pharmacol. 2011;27(3):358.

Kumar RD, Hirsch NP. Clinical evaluation of stethoscope‐guided inflation of tracheal tube cuffs. Anaesthe. 2011;66(11):1012-6.

Sinha SK, Nicks JJ, Donn SM. Graphic analysis of pulmonary mechanics in neonates receiving assisted ventilation. Arch Dis Childhood Fetal Neonatal Ed. 1996;75(3):F213.

Seegobin RD, Van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed). 1984;288(6422):965-8.

Vyas D, Inweregbu K, Pittard A. Measurement of tracheal tube cuff pressure in critical care. Anaesthe. 2002;57(3):275-7.

Chopra M, Jones L, Boulanger C, Benger J, Higginson I, Williamson D, et al. Prospective observational measurement of tracheal tube cuff pressures in the emergency department. Emerg Med J. 2010;27(4):270-1.

Galinski M, Tréoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Annals Emerg Med. 2006;47(6):545-7.

Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006;24(2):139-43.

Hoffman RJ, Parwani V, Kaban J, Dueffer H, Howell A, Sturmann K. 86: Comparison of Two Common Techniques for Inflating Endotracheal Tube Cuffs: Set Volume of Air Vs. Palpation of the Pilot Balloon. Annals Emerg Med. 2006;48(4):27.

Wain JC. Postintubation tracheal stenosis. Chest Surg Clin. 2003;13(2):231-46.

Carroll RG, Mcginnis GE, Grenvik A. Performance characteristics of tracheal cuffs. Intern Anesthesiol Clinics. 1974;12(3):111-42.

American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respiratory Critical Care Med. 2005;171(4):388.

Janossy KM, Pullen J, Young D, Bell G. The effect of pilot balloon design on estimation of safe tracheal tube cuff pressure. Anaesthe. 2010;65(8):785-91.

Almarakbi WA, Kaki MA. Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff –related complications: Prospective, randomized, clinical trial. Saudi J Anaesth. 2014;8(3):328-34.