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Changes in intracuff pressure of a cuffed endotracheal tube during prolonged surgical procedures
Hiromi Kako1, Anatoliy Goykhman2, Archana S Ramesh3
1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, USA.
Insights
Continuous monitoring of endotracheal tube cuff pressure in pediatric patients is crucial. Significant pressure variations can occur during prolonged surgeries, necessitating careful management to prevent complications.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Redesigned cuffed endotracheal tubes (ETTs) are increasingly used in pediatric patients.
- Despite design improvements, ETT cuff hyperinflation can impair tracheal mucosal perfusion.
- Prolonged surgical procedures pose a risk for unintended cuff pressure changes.
Purpose of the Study:
- To prospectively monitor intracuff pressure changes in pediatric patients during prolonged surgery.
- To assess the incidence and magnitude of intracuff pressure variations.
- To determine the clinical implications of these pressure fluctuations.
Main Methods:
- Study included 30 pediatric patients undergoing prolonged surgery (>4h) with cuffed ETTs.
- Intracuff pressure was continuously measured using a transducer connected to the pilot balloon.
- Measurements were recorded at 15-minute intervals for the first hour, then every 30 minutes.
Main Results:
- Intracuff pressure varied significantly, with changes ranging from -25.8 to +16.3 cmH2O.
- 30% of patients experienced a decrease of ≥10 cmH2O, and 20% had an increase of ≥10 cmH2O.
- 17% of patients had intracuff pressure >30 cmH2O at some point; no patient maintained baseline pressure.
Conclusions:
- Significant intracuff pressure variations occur during prolonged pediatric surgeries.
- These unintended pressure changes can affect patient outcomes.
- Continuous monitoring of intracuff pressure is recommended when using cuffed ETTs in children for extended procedures.
Background:
With the introduction of redesigned cuffed endotracheal tubes (ETTs), there has been an increasing trend toward their use in pediatric patients. Despite improvements in design, an unintended and prolonged hyperinflation of the cuff can compromise tracheal mucosal perfusion. The current study prospectively monitors changes in intracuff pressure continuously in pediatric patients undergoing prolonged surgical procedures.
Methods:
The study was conducted on pediatric patients who were scheduled to undergo prolonged surgical procedures (more than 4h) with a cuffed ETT. After placement of the cuffed ETT, the cuff was inflated using the air-leak test with a CPAP of 20cmH2O in the anesthesia circuit. After inflation, the inflating port of the pilot balloon was connected to the transducer of the invasive pressure monitoring device using our previously described technique to continuously measure the intracuff pressure. Measurements were recorded every 15min for the first 1h, and then every 30min throughout the surgical procedure.
Results:
The study cohort included 30 patients who ranged in age from 1.2 to 17.6 years and in weight from 9.4 to 113.4kg. There were 16 boys and 14 girls. The size of the cuffed ETT ranged from 3.5mm to 8.0mm ID. The baseline intracuff pressure at the time of inflation was 17.6±8.8cmH2O. The absolute change in the intraoperative intracuff pressure when compared to the baseline intracuff pressure ranged from -25.8 to +16.3cmH2O. In 9 patients (30%), the decrease of the intracuff pressure was ≥10cmH2O. In 6 patients (20%), the increase of the intracuff pressure was ≥10cmH2O. In 5 of 30 patients (17%), the absolute intracuff pressure was greater than 30cmH2O at least once intraoperatively. In no patient, did the intracuff pressure remain the same as the baseline throughout the procedure.
Conclusion:
We noted significant variations in the intracuff pressure during prolonged surgical procedures. These unintended changes, both increases and decreases, may impact the perioperative course of patients. Our study suggests the need for continuously monitoring intracuff pressure if a cuffed ETT is used in children for prolonged surgical procedures.
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