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Verma A, Singh G, Trivedi V, Ramkiran KS, Babu MJ, Pandya H, Pujara J. Effect of transesophageal echocardiography probe on tracheal perfusion pressure and ventilatory parameters in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass: A prospective observational study. Ann Card Anaesth 2023; 26:393-398. [PMID: 37861572 PMCID: PMC10691560 DOI: 10.4103/aca.aca_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Overinflation of cuffed endotracheal tubes and transesophageal echocardiography (TEE) probe causes increased intracuff pressure (CP) compromising tracheal perfusion pressure (TPP). Primary objective of the study was to assess CP, TPP on TEE probe insertion and examination during pediatric cardiac surgeries. Secondary objectives were to evaluate the effect of the probe on peak airway pressures (Ppeak), mean airway pressures (Pmean) and to monitor CP, TPP on cardiopulmonary bypass (CPB). Materials and Methods This prospective observational study included fifty patients, aged 1-5 years undergoing cardiac surgeries using CPB. Following induction, TEE probe was introduced. CP, TPP, Ppeak, Pmean were measured before insertion of TEE probe (T1), during probe insertion (T2) and examination at mid-esophageal (T3), transgastric level (T4), and on removing probe (T6). CP, TPP were monitored on CPB (T5). Statistical analysis was done using paired t-test. Results CP, Ppeak and Pmean increased significantly, while TPP decreased significantly from T1 to T2, T3, T4 (P < 0.001). CP, TPP decreased significantly at T5 in comparison to T6 (P < 0.001). In 48% of the patients CP increased above 30 cm H2O at T2. Conclusion TEE probe causes an increase in CP and decreases TPP. Constant monitoring and maintaining CP, TPP in optimum range is recommended.
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Affiliation(s)
- Abhishek Verma
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Guriqbal Singh
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Visharad Trivedi
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - KS Ramkiran
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Mittapalli Jeevan Babu
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Himani Pandya
- Department of Research, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Jigisha Pujara
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Hung KC, Chang YJ, Chang YP, Ho CN, Lan KM, Chen JY, Wang LK, Huang PW, Sun CK. The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis. Sci Rep 2022; 12:18192. [PMID: 36307502 PMCID: PMC9616852 DOI: 10.1038/s41598-022-21980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.
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Affiliation(s)
- Kuo-Chuan Hung
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ying-Jen Chang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yang-Pei Chang
- grid.412019.f0000 0000 9476 5696Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan ,grid.412027.20000 0004 0620 9374Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Mao Lan
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Li-Kai Wang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ping-Wen Huang
- grid.452796.b0000 0004 0634 3637Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Cheuk-Kwan Sun
- grid.414686.90000 0004 1797 2180Department of Emergency Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445 Taiwan ,grid.411447.30000 0004 0637 1806College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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Maddali MM, Al Hadifi TSM, Sathiya PM, Jose S. The Effect of Intraoperative Transesophageal Echocardiography Probe Placement on the Endotracheal Tube Cuff Pressure in Adult Patients Undergoing On-Pump Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:3084-3089. [PMID: 35365372 DOI: 10.1053/j.jvca.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The study was directed toward documentation of the effect of transesophageal echocardiography (TEE) probe insertion on the endotracheal tube cuff pressure (CP) in adult patients undergoing on-pump coronary bypass surgery. The primary objective of this study was to assess whether CP reaches supranormal pressures during the different stages of intraoperative TEE examination. The secondary objective was to observe the effect of TEE probe placement on the ventilation parameters. DESIGN A prospective observational study. SETTING At a tertiary care cardiac center. PARTICIPANTS Thirty-four cardiac surgical patients older than 18 years of age who required intraoperative TEE examination. INTERVENTIONS TEE probe insertion. MEASUREMENTS AND MAIN RESULTS Following the induction of general anesthesia and tracheal intubation, a TEE probe was introduced. The endotracheal tube CP was recorded at 5 time zones: Before TEE probe insertion, during the insertion of the probe, during probe manipulation, probe in the transgastric position, and during removal of the probe. A nonparametric test was used for comparing intracuff pressure between pairs of time zones. There was a statistically significant difference in CP values between the baseline and those during different time zones (chi-square test = 134.77, degrees of freedom = 4, p = 0.001). There was a statistically significant difference in the peak pressure between different time points compared to baseline (p = 0.0001). CONCLUSIONS TEE probe placement in patients with tracheal intubation may be associated with a significant increase in CP well above the baseline pressure. With the possibility of the mean arterial pressures during cardiopulmonary bypass being substantially lower than expected, the findings of the current study raised the concern of predisposing the tracheal mucosa to hypoperfusion, with subsequent temporary or permanent tracheal damage. Hence, at least a baseline estimation of the endotracheal tube CP at the time of tracheal intubation, with the help of a pressure gauge in the operating room, may be considered as a safe practice.
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Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | | | | | - Sachin Jose
- Department of Studies and Research, Oman Medical Specialty Board, Muscat, Oman
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