scholarly journals Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Fred Bulamba ◽  
Andrew Kintu ◽  
Nodreen Ayupo ◽  
Charles Kojjo ◽  
Lameck Ssemogerere ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Elective Surgery ◽  
Cuff Pressure ◽  
Mulago Hospital ◽  
Pilot Balloon ◽  
Resource Limited ◽  
Anesthesia Providers ◽  
Loss Of Resistance ◽  
Pressure Manometer ◽  
Study Participants

Background. Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods. This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results. One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.

scholarly journals Post-operative Sore Throat: Comparing the Monitored Endotracheal Tube Cuff Pressure and Pilot Balloon Palpation Methods

2019 ◽  
Vol 26 (5) ◽  
pp. 132-138
Author(s):  
Nagappan Ganason ◽  
◽  
Vanitha Sivanaser ◽  
Chian Yong Liu ◽  
Muhammad Maaya ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Sore Throat ◽  
Cuff Pressure ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Pilot Balloon ◽  
Endotracheal Tube Cuff Pressure

scholarly journals Comparison of endotracheal tube cuff inflation techniques by stethoscope and “just seal” method in patients undergoing surgeries under general anesthesia

2019 ◽  
Vol 5 (1) ◽  
pp. 16-21
Author(s):  
Mona Rajbhandari ◽  
Nagendra Bahadur KC ◽  
Bhuban Raj Kunwar ◽  
Bindu Laxmi Shah
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Elective Surgery ◽  
Cuff Pressure ◽  
Thyroid Cartilage ◽  
Cuff Inflation ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Tracheal Cuff

Background: Overinflation of the endotracheal tube cuff affects tracheal mucosa blood supply that causes postoperative complications like cough, sore throat and hoarseness. There is no standard cuff inflation technique that produces appropriate cuff pressure. The aim of this study was to find out better technique of cuff inflation that will produce adequate pressure with limited complication using stethoscope guided and “just seal”. Methods: This was prospective, randomized single blinded study of 100 American Society of Anesthesiologists Physical Status (ASA PS) I and II patients of 18-65 years undergoing elective surgery under general anesthesia requiring endotracheal intubation. Group J (n=50) received ‘just seal’ method of tracheal cuff inflation where air was introduced into cuff until audible leak at mouth disappeared and Group S (n=50) received stethoscope-guided tracheal cuff inflation where air was introduced into cuff until harsh breath sound changed to soft while listening with stethoscope bell over the thyroid cartilage. Volume of air in endotracheal tube cuff, cuff pressure following inflation and post-operative sore throat, hoarseness and cough at 24 hour were assessed. Results: Demographic details, mean volume of air in cuff, mean cuff pressure and incidence of postoperative adverse effects like sore throat, hoarseness and cough at 24 hours between the groups were comparable. Conclusion: Both the stethoscope guided and “just seal” cuff inflation techniques were equally effective in producing adequate cuff pressure of 20-30 cmH2O with limited complication.

Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator

2019 ◽  
Vol 22 (7) ◽  
pp. 641-647
Author(s):  
Donna M White ◽  
Mariano Makara ◽  
Fernando Martinez-Taboada
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
High Volume ◽  
Intracuff Pressure ◽  
Cuff Inflation ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Passive Release ◽  
Digital Pressure ◽  
Loss Of Resistance

Objectives The aim of this study was to compare four inflation techniques on endotracheal tube cuff (ETC) pressure using a feline airway simulator. Methods Ten participants used four different endotracheal cuff inflation techniques to inflate the cuff of a low-pressure, high-volume endotracheal tube within a feline airway simulator. The simulator replicated an average-sized feline trachea, intubated with a 4.5 mm endotracheal tube, connected to a circle breathing system and pressure-controlled ventilation with oxygen and medical air. Participants inflated the ETC: by pilot balloon palpation (P); by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during mechanical ventilation; until a passive release of pressure with use of a loss-of-resistance syringe (LOR); and with use of a syringe with a digital pressure reader (D) specifically designed for endotracheal cuff inflation. Intracuff pressure was measured by a manometer obscured to participants. The ideal pressure was considered to be between 20 and 30 cmH2O. Data were analysed by Shapiro–Wilk, Kruskal–Wallis and χ2 tests, as appropriate. Results Participants were eight veterinarians and two veterinary nurses with additional training in anaesthesia. Measured median intracuff pressures for P, MOV, LOR and D, respectively, were 25 cmH2O (range 4–74 cmH2O), 41 cmH2O (range 4–70 cmH2O), 31 cmH2O (range 18–64 cmH2O) and 22 cmH2O (range 20–30 cmH2O). D performed significantly better ( P <0.001) than all other techniques, with no difference between the other techniques. Conclusions and relevance Use of D for cuff inflation achieved optimal cuff pressures. There may be high operator-dependent variability in the cuff pressures achieved with the use of P, MOV or LOR inflation techniques. As such, a cuff manometer is recommended when using any of these techniques.

scholarly journals Changes in the Bronchial Cuff Pressure of Left-Sided Double-Lumen Endotracheal Tube by Lateral Positioning: A Prospective Observational Study

2021 ◽  
Vol 10 (8) ◽  
pp. 1590
Author(s):  
Jong-Hae Kim ◽  
Eugene Kim ◽  
In-Young Kim ◽  
Eun-Joo Choi ◽  
Sung-Hye Byun
Keyword(s):  
Thoracic Surgery ◽  
Endotracheal Tube ◽  
Primary Outcome ◽  
Cuff Pressure ◽  
Lateral Decubitus Position ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Bronchial Cuff ◽  
Lateral Decubitus ◽  
Lateral Positioning

Proper bronchial cuff pressure (BCP) is important when using a double-lumen endotracheal tube (DLT), especially in thoracic surgery. As positional change during endotracheal tube placement could alter cuff pressure, we aim to evaluate the change in BCP of DLT from the supine to the lateral decubitus position during thoracic surgery. A total of 69 patients aged 18–70 years who underwent elective lung surgery were recruited. BCP was measured at a series of time points in the supine and lateral decubitus positions after confirming the DLT placement. The primary outcome was change in the initial established BCP (BCPi), which is the maximum pressure at which the BCP did not exceed 40 cmH2O without air leak in the supine position, after lateral decubitus positioning. As the primary outcome, the BCPi increased from 25.4 ± 9.0 cmH2O in the supine position to 29.1 ± 12.2 cmH2O in the lateral decubitus position (p < 0.001). Out of the 69 participants, 43 and 26 patients underwent surgery in the left-lateral decubitus position (LLD group) and the right-lateral decubitus position (RLD group) respectively. In the LLD group, the BCPi increased significantly (p < 0.001) after lateral positioning and the beginning of surgery and the difference value, ∆BCPi, from supine to lateral position was significantly higher in the LLD group than in the RLD group (p = 0.034). Positional change from supine to lateral decubitus could increase the BCPi of DLT and the increase was significantly greater in LLD that in RLD.

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