Comparison of different endotracheal tube cuff pressure maintain methods in ICU

Subbotin V., Malakhova A.
Vishnevski Surgery Institute, Moscow, Russia

Background and Goal of Study: Endotracheal tube cuff underinflation and hyperinflation are associated with different complications [1, 2, 3]. Recommended pressure is 20-30 cmH2O. The aim of this study was to compare different methods to maintain optimal cuff pressure.

Materials and methods: 90 patients were included in prospective observational cohort study. All patients were divided in to 3 groups according to cuff pressure maintain device: 1 group – syringe with subsequent guided by mechanical manometer every 1 h; 2 group – mechanical manometer guided with continuous cuff pressure measurement; 3 group – cuff pressure was maintaining by automated pneumatic line from ventilator, MythoVent (MS Westfalia GmbH, Germany). We used high-volume low-pressure endotracheal tube only. Cuff pressure was recording every 1 h within 8 h. Underinflation and hyperinflation of the endotracheal cuff were defined as cuff pressure less than 20 cmH2O and more than 30 cmH2O, respectively. Identified changes in pressure were corrected by syringe in the first group, by manometer in the second and by pneumatic line from ventilator in the third group.

Results and discussion: It was made 240 measurements in each group.

 

1 group

2 group

3 group

underinflation

31

15

3

hyperinflation

25

6

9

normal

184

219

228

Quantity of cases with underinflation and hyperinflation were more in the 1 group in comparison with second and third groups significantly (p<0,05 Chi – square)

20 hyperinflation cases in the 1 group have been associated with initial cuff inflation by syringe. The reason of hyperinflation in the other five cases in this group was the need for lung ventilation with high airway pressure (above 35 cmH2O). The same reason of hyperinflation was in the 2 and 3 group. All cases of underinflation have been associated with human factors in the first group (staff feared to hyperinflate a cuff). 15 cases of underinflation in the second group have been associated with manometer leakage. 3 cases of underinflation in the third group have been associated with pneumatic line disconnection.

Conclusion(s): The “Human factor” was the leader reason of cuff pressure abnormality in the ICU. Continuous pressure monitoring devices allow to avoid hyper- and underinflation of endotracheal tube cuff. But it is very important to remember that mechanical manometer may be the reason of air leakage from the endotracheal tube cuff.

References:

  1. Nseir S et al Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur J Anaesthesiol. 2009 Mar;26(3):229-34.
  2. Nseir S et al Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care. 2007;11(5):R109.
  3. Sridermma S et al Development of appropriate procedures for inflation of endotracheal tube cuff in intubated patients J Med Assoc Thai. 2007 Nov;90 Suppl 2:74-8.

Аcknowledgements: No financial support or sponsorship has been received for this trial. None of the author has any conflicts of interest.