A mathematical model of differential tracheal tube cuff pressure: effects of diffusion and temperature

Measuring endotracheal tube intracuff pressure: no room for complacency

Tracheal intubation constitutes a routine part in the care of critically ill and anaesthetised patients. Prolonged use of endotracheal with inflated cuff is one of the major multifactorial causes of complications. Both under-inflation and over-inflation of cuff are associated with complications. Despite known problems, regular measurement of cuff pressure is not routine, and it is performed on an ad hoc basis.

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46.07±23.54 cmH2O in the fixed volume group and 33.72±9.14 cmH2O in the MLT group (P=0.05) which is significantly higher in the fixed volume group (P=0.028). In addition, 56.4% and 78.2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P=0.025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.

Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure

OBJECTIVE

To test the agreement between two handcrafted devices and a cuff-specific manometer.

METHODS

The agreement between two handcrafted devices adapted to measure tracheal tube cuff pressure and a cuff-specific manometer was tested on 79 subjects. The cuff pressure was measured with a commercial manometer and with two handcrafted devices (HD) assembled with aneroid sphygmomanometers (HD1 and HD2). The data were compared using Wilcoxon and Spearman tests, the intraclass correlation coefficient (ICC) and limit-of-agreement analysis.

RESULTS

Cuff pressures assessed with handcrafted devices were significantly different from commercial device measurements (pressures were higher when measured with HD1 and lower with HD2). The ICCs between the commercial device and HD1 and HD2 were excellent (ICC = 0.8 p < 0.001) and good (ICC = 0.66, p < 0.001), respectively. However, the Bland- Altman plots showed wide limits of agreement between HD1 and HD2 and the commercial device.

CONCLUSION

The handcrafted manometers do not provide accurate cuff pressure measurements when compared to a cuff-specific device and should not be used to replace the commercial cuff manometers in mechanically ventilated patients.

Do current methods for endotracheal tube cuff inflation create pressures above the recommended range? A review of the evidence

Inflation and measurement of endotracheal (ET) tube cuff pressure is often not seen as a critical aspect of care in surgical patients. The morbidity associated by an overinflated cuff has been regularly highlighted in literature, for example mucosal ulceration (Combes et al 2001) and vocal cord paralysis (Holley & Gildea 1971). This article will outline techniques for the methods of inflation based on the latest scientific evidence. The author will seek to examine if intraoperative cuff assessment and monitoring should become routine for the anaesthetic practitioner and if current practice for inflating cuffs creates pressures outside the safe range.

Do current methods for endotracheal tube cuff inflation create pressures above the recommended range? A review of the evidence

Inflation and measurement of endotracheal (ET) tube cuff pressure is often not seen as a critical aspect of care in surgical patients. The morbidity associated by an overinflated cuff has been regularly highlighted in literature, for example mucosal ulceration (Combes et al 2001) and vocal cord paralysis (Holley & Gildea 1971). This article will outline techniques for the methods of inflation based on the latest scientific evidence. The author will seek to examine if intra-operative cuff assessment and monitoring should become routine for the anaesthetic practitioner and if current practice for inflating cuffs creates pressures outside the safe range.

Endotracheal tube cuff pressure monitoring: a review of the evidence

Tracheal intubation constitutes a routine part of anaesthetic practice both in the operating theatre as well as in the care of critically ill patients. The procedure is estimated to be performed 13-20 million times annually in the United States alone. There has been a recent renewal of interest in the morbidity associated with endotracheal tube cuff overinflation, particularly regarding the rationale and requirement for endotracheal tube cuff monitoring intra-operatively.