scholarly journals Comparison of three different techniques of endotracheal tube cuff inflation: just seal, stethoscope guided and pressure volume loop: a prospective randomized study

2020 ◽  
Vol 8 (2) ◽  
pp. 512
Author(s):  
Mamta Bhardwaj ◽  
Kiranpreet Kaur ◽  
Asha Sharma ◽  
Prashant Kumar ◽  
Raj Tobria ◽  
...  
Keyword(s):  
Cuff Pressure ◽  
Randomized Study ◽  
Good Alternative ◽  
Prospective Randomized Study ◽  
Positive Pressure ◽  
Cuff Inflation ◽  
Suprasternal Notch ◽  
Tube Cuff ◽  
Gastric Secretions ◽  
Tracheal Cuff

Background: Cuffed endotracheal tubes not only ensure a proper seal during positive pressure ventilation, but at the same time also prevent aspiration of gastric secretions. The aim of this prospective, randomized study was to compare three methods of ETT cuff inflation-- palpation of the leak in suprasternal notch (Just seal), a stethoscope guided method of tracheal tube cuff inflation and PVL guided cuff inflation.Methods: After approval by institutional ethical committee, 192 patients of either sex in age group of 18-50 years belonging to ASA physical status I or II were enrolled. Each patient was randomly allocated into one of three groups: one group received standard 'just seal' method of tracheal cuff inflation (JS), the second group, the stethoscope-guided method (SG) and in third group cuff was inflated using Pressure Volume Loop (PVL). Volume of air introduced into the cuff and pressure within the cuff was recorded.Results: A total of 192 patients were recruited to the study. The median (IQR [range]) tracheal cuff pressure was 12 (10-22 [6-28]) cm H2O, 16 (12-24[6-38]) and 14 (10-22[8-32]) cmH2O in JS, SG and PVL group respectively. Cuff pressures within the recommended range of 20-30 cm H2O fell in 25% of the patients in both JS and SG group and 31% patients in PVL group. The mean volumes of air introduced in the cuff and the resultant mean cuff pressure in all groups was found to be statistically insignificant (p= 0.4, 0.18 respectively). Tidal volume discrepancy was more and 75% of cuff pressures were less than the recommended range in JS than the other two groups.Conclusions: Real time PVL displayed on most modern anaesthesia machine is a good alternative to check for proper ETT cuff inflation, avoid high cuff pressure and monitor air leak.

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.

scholarly journals Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study

2011 ◽  
Vol 5 (2) ◽  
pp. 185 ◽  
Author(s):  
RoshdiR Al-metwalli ◽  
HanyA Mowafi ◽  
Mohammed Abdulshafi ◽  
AbdulmohsenA Al-Ghamdi ◽  
Sayed Sadek ◽  
...  
Keyword(s):  
Comparative Study ◽  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Cuff Inflation ◽  
Endotracheal Tube Cuff ◽  
Tube Cuff ◽  
Safe Technique

scholarly journals What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

2020 ◽  
Vol 44 (5) ◽  
pp. 402-408
Author(s):  
Dong Min Kim ◽  
Myung Jun Shin ◽  
Sung Dong Kim ◽  
Yong Beom Shin ◽  
Ho Eun Park ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Cadaver Study ◽  
Cuff Inflation ◽  
Cuff Volume ◽  
Tube Cuff ◽  
Different Types ◽  
Male Cadaver ◽  
Tracheostomy Tubes ◽  
Pressure Changes

Objective To determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy.Methods We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer.Results For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH<sub>2</sub>O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH<sub>2</sub>O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types.Conclusion Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

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.

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