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      Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure

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          Cuff pressure in endotracheal (ET) tubes should be in the range of 20–30 cm H 2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used.


          With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Anesthetists were blinded to study purpose. Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Nitrous oxide was disallowed. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH 2O.


          Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 ± 21.6 cmH 2O). Only 27% of pressures were within 20–30 cmH 2O; 27% exceeded 40 cmH 2O. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH 2O was similar with each tube size.


          We recommend that ET cuff pressure be set and monitored with a manometer.

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          Most cited references 22

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          Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.

          Large volume, low pressure endotracheal tube cuffs are claimed to have less deleterious effect on tracheal mucosa than high pressure, low volume cuffs. Low pressure cuffs, however, may easily be overinflated to yield pressures that will exceed capillary perfusion pressure. Various large volume cuffed endotracheal tubes were studied, including Portex Profile, Searle Sensiv, Mallinkrodt Hi-Lo, and Lanz. Tracheal mucosal blood flow in 40 patients undergoing surgery was assessed using an endoscopic photographic technique while varying the cuff inflation pressure. It was found that these cuffs when overpressurised impaired mucosal blood flow. This impairment of tracheal mucosal blood flow is an important factor in tracheal morbidity associated with intubation. Hence it is recommended that a cuff inflation pressure of 30 cm H2O (22 mm Hg) should not be exceeded.
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            Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube.

            This study compared the recently introduced Microcuff endotracheal tube HVLP ICU featuring an ultrathin (7-microm) polyurethane cuff membrane with endotracheal tubes from different manufacturers regarding fluid leakage past the tube cuff. In vitro setup. The following endotracheal tubes (ID 7.5 mm) were compared: Mallinckrodt HiLo, Microcuff HVLP ICU, Portex Profile Soft Seal, Rüsch Super Safety Clear, and Sheridan CF. A vertical PVC trachea model (ID 20 mm) was intubated, and cuffs were inflated to 10, 15, 20, 25, 30, and 60 cmH2O. Colored water (5 ml) was added to the top of the cuff. The amount of leaked fluid past the tube cuff within 5, 10, and 60 min was recorded. Experiments were performed four times using two examples of each tube brand. Fluid leakage past tube cuffs occurred in all conventional endotracheal tubes at cuff pressures from 10 to 60 cmH2O. In the Microcuff tube cuff pressure fluid leakage was observed within 10 min only at 10 cmH2O. Results with the Microcuff tube were significantly better than all other tube brands at cuff pressures of 10-30 cmH2O. Within the acceptable upper limit for tracheal cuff pressure (25-30 cmH2O) the Microcuff endotracheal tube was the only one of the tested tubes to prevent fluid leakage in our in vitro setup. In vivo studies are required to confirm these findings.
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              Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics.

              This study compared intracuff pressure (ICP) during mechanical ventilation in a variety of currently used endotracheal (ET) and tracheostomy (trach) tube cuffs and related cuff physical characteristics. Tracheostomy tube physical characteristics were also measured. Variation was observed to exist between "just-seal" inspiratory and end-expiratory intracuff pressure during mechanical ventilation. Cuff diameter, thickness, compliance, geometry (shape), resting volume, and just-seal volume also varied. ICP varied with cuff diameter, thickness, compliance, geometry (shape), and trachea size, as well as tube curve and cuff position in the trachea. Thin, large-diameter, compliant cuffs generally "just seal" with relatively low ICPs. We recommend use of tracheal airways (endotracheal and tracheostomy) fitted with cuffs that seal in patients with low intracuff pressures. We also recommend nonrigid (soft) thermolabile tracheostomy tubes.

                Author and article information

                BMC Anesthesiol
                BMC Anesthesiology
                BioMed Central (London )
                29 November 2004
                : 4
                : 8
                [1 ]Outcomes Research™ Institute, University of Louisville, 501 E. Broadway, Suite 210, Louisville, KY 40202, USA
                [2 ]Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 S. Jackson St. University Hospital, Louisville, KY 40202, USA
                [3 ]School of Medicine, University of Louisville School of Medicine, Louisville, KY 40292, USA
                Copyright © 2004 Sengupta et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Research Article

                Anesthesiology & Pain management


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