Frequency of inappropriate endotracheal tube cuff pressure and its variability in patients undergoing prolonged surgery: A prospective observational study
Endotracheal tube cuff pressure variation under general anaesthesia
DOI:
https://doi.org/10.55519/JAMC-02-11858Keywords:
General anaesthesia, Endotracheal tube, Intraoperative monitoring, Cuff pressure, Prolonged surgeryAbstract
Background: Endotracheal tube (ETT) is inserted into the trachea to maintain the airway patency. Maintaining adequate ETT cuff pressure is important to ensure a proper seal to lower the risk of aspiration and tracheal trauma. This study was designed to assess the frequency of inappropriate ETT cuff pressure at the time of intubation and variation in ETT pressure at the end of a prolonged surgery. Methods: This study was conducted in the Department of Anaesthesiology, Aga Khan University from October 2019 to March 2020. All adult patients of both genders, undergoing prolonged surgery under general anaesthesia were included. Patients were intubated with an appropriate size ETT, and the cuff was inflated with air. ETT cuff pressure was measured after intubation and, if inappropriate, was adjusted to an appropriate level. ETT cuff pressure reading was noted at the end of prolonged surgery to assess any variation. Results: Fifty-eight patients were included, 64% were females. The mean age was 47.36 years. The frequency of inappropriate ETT cuff pressure at the time of intubation was 60.3% which was corrected before the start of surgery. At the end of surgery, 70.7% of patients showed variations in ETT cuff pressures with majority (33%) having a variation of 51 to 70 (81-100 cm H2O). Conclusions: The frequency of inappropriate endotracheal tube cuff pressure at the time of intubation was found to be 60.3%. In 70.7% of patients, ETT cuff pressure at the end of prolonged surgery was inappropriate.References
Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care 2011;20(2):109-18.
Jordan P, Van Rooyen D, Venter D. Endotracheal tube cuff pressure management in adult critical care units. South Afr J. Crit. Care 2012;28(1):13-6.
Khan MU, Khokar R, Qureshi S, Al Zahrani T, Aqil M, Shiraz M. Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method. Saudi J Anaesth 2016;10(4):428-31.
Miyashiro RM, Yamamoto LG. Endotracheal tube and laryngeal mask airway cuff pressures can exceed critical values during ascent to higher altitude. Pediatr Emerg Care 2011;27(5):367-70.
Brendt P, Schnekenburger M, Paxton K, Brown A, Mendis K. Endotracheal tube cuff pressure before, during, and after fixed-wing air medical retrieval. Prehosp Emerg Care 2013;17(2):177-80.
Ansari L, Bohluli B, Mahaseni H, Valaei N, Sadr-Eshkevari P, Rashad A. The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: A randomized double-blind controlled clinical trial. J Oral and Maxillofacial Surgery 2013;52:140-43.
Sultan P, Carvalho B, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: a review of the evidence. J Perioper Pract 2011;21(11):379-86.
Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery-Manual vs. automatic method. J Anaesthesiol, Clin Pharmacol. 2011;27(3):358-61.
Balakrishnan S, Jacob KK. Cuff pressure manometer-a luxury or necessity. Indian J Clin Anaesth 2016;3(4):588-92.
Koşar Ö, Şen Ö, Toptaş M, Mısırlıoğlu G, Aydın N, Gür EK, Umutoğlu T. Effect of Nitrous Oxide Anaesthesia on Endotracheal Cuff Pressure. Haseki Tip Bulteni 2017;55(1):37-41
Das S, Kumar P. Comparison of minimal leak test and manual cuff pressure measurement technique method for inflating the endotracheal tube cuff. Indian J Clin Anaesth 2015;2(2):78-81.
Selman Y, Arciniegas R, Sabra JM, Ferreira TD, Arnold DJ. Accuracy of the Minimal Leak Test for Endotracheal Cuff Pressure Monitoring. Laryngoscope 2019;130:1646–50.
Gilliland L, Perrie H, Scribante J. Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg Academic Hospitals. Anaesth Analg 2015;21(3):81-4.
Grant T. Do current methods for endotracheal tube cuff inflation create pressures above the recommended range? A review of the evidence. J Perioperative Practi 2013;23, 292-95.
Jaensson M, Gupta A, Nilsson U. Risk factors for development of postoperative sore throat and hoarseness after endotracheal intubation in women: A secondary analysis. AANA J 2012;80:67-73.
Tsaousi G, Pourzitaki C, Chlorou D, Papapostolou K, Vasilakos D. Benchmarking the applicability of four methods of endotracheal tube cuff inflation for optimal sealing: A randomized trial. J Perianesth Nurs 2018;33(2):129-37.
Purchon R. Endotracheal tubes, cuff pressures in cardiac surgery. Operat Theat J 2017;324:14-17.
Tobias JD, Schwartz L, Rice J, Jatana K, Kang DR. Cuffed endotracheal tubes in infants and children: Should we routinely measure the cuff pressure? Intern J Pediatric Otolary 2012;76: 61-63.
Siamdoust SA, Mohseni M, & Memarian A. Endotracheal tube cuff pressure assessment: Education may improve but not guarantee the safety of palpation technique. Anesthesiol Pain Med 2015;5(3):1-5.
Stewart SL, Seacrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intra-cuff measurement. AANA J 2003;71:443-47.
Totonchi Z, Jalili F, Hashemian SM, Jabardarjani HR. Tracheal stenosis and cuff pressure: Comparison of minimal occlusive volume and palpation techniques. J Respiratory Disease, Thoracic Surg, Intensive Care, and Tuberculosis 2015;14:252-56.
Sengupta P, Sessler D, Maglinger P, Wells S, Vogt A, Durrani J, et al. Endotracheal tube cuff pressures in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol 2004:4(8):1-6.
Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, Hang Y. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: A multicenter study. Anesth Analg 2010;111(5):1133-7.
Harvie DA, Darvall JN, De La Cruz A, Dodd M, Tracey M, D’Costa RL, et al. The minimal leak test technique for endotracheal cuff maintenance. Anaesth Intensive Care 2016;44:599-604.
Lehmann M, Monte K, Barach P, Kindler CH. Postoperative patient complaints: a prospective interview study of 12,276 patients. J Clinical Anesthesia 2010;22:13-21.
Hockey CA, van Zundert AA, Paratz JD. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis. Anaesth Intensive Care 2016;44(5):560-70.
Kako H, Goykhman A, Ramesh AS, Krishna SG, Tobias JD. Changes in intracuff pressure of a cuffed endotracheal tube dur ing prolonged surgical procedures. Int J Pediatr Otorhinolar- yngol 2015;79:76-79.
Abubaker J, Zia Ullah S, Ahmed S, Rehman Memon AU, Abubaker ZJ, Ansari MI, Karim M. Evaluating the Knowledge of Endotracheal Cuff Pressure Monitoring Among Critical Care Providers by Palpation of Pilot Balloon and By Endotracheal Tube Cuff Manometer. Cureus. 2019 Jul 1;11(7):e5061.
Kumar CM, Seet E, Van Zundert TCRV. Measuring endotracheal tube intracuff pressure: no room for complacency. J Clin Monit Comput 2021;35(1):3-10.
Xiang L, Cao M, Song X, Tan M, Deng T, Wang Y, Zhang X. The effect of different inflating volume on the measurement accuracy of the modified cuff pressure measurement method. J Clin Monit Comput. 2022;36(2):521-528.
Al-metwalli RR, Fallatah SM, Alghamdi TM. Endotracheal tube cuff pressure: An overlooked risk. Anaesth. pain intensive care 2021;25(1):88-97.
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