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Published on: January 17, 2011
Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing
Farhan Shaikh1, Yeshwanth R Janaapureddy1, Shashwat Mohanty1
1Department of Pediatric Intensive Care Unit, Rainbow Children' s Hospital, Hyderabad, Telangana, India.
Insights
Protocolized monitoring of endotracheal tube cuff pressure did not reduce post-extubation stridor or re-intubation rates in children. Clinical assessment alone may suffice, potentially ending routine cuff pressure measurements.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Mechanical Ventilation
Background:
- Endotracheal tube (ETT) cuff pressure management is crucial in mechanically ventilated children.
- Current practices often rely on bedside clinical assessment.
- The efficacy of routine, protocolized cuff pressure monitoring requires further investigation.
Purpose of the Study:
- To compare protocolized ETT cuff pressure monitoring with standard clinical assessment.
- To determine if routine monitoring reduces adverse post-extubation events in pediatric patients.
Main Methods:
- A single-center prospective randomized controlled study involving children aged 1 month to 18 years.
- Two groups: standard group (clinical assessment) and monitoring group (device-based pressure control).
- Outcomes included post-extubation stridor, re-intubation, VAP, ventilator days, and PICU stay.
Main Results:
- No significant difference was found in post-extubation stridor, re-intubation rates, or VAP between the groups.
- Ventilator days and pediatric intensive care unit (PICU) length of stay were also similar.
- Protocolized monitoring offered no advantage over clinical assessment in this pediatric cohort.
Conclusions:
- Routine ETT cuff pressure measurement may not be necessary in mechanically ventilated children.
- Clinical assessment of ETT cuff inflation appears sufficient.
- Further large-scale multicentric studies are recommended to confirm these findings.
Objective:
To study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment.
Materials And Methods:
This was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg.
Results:
Out of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables.
Conclusion:
Our findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098).Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737.
How To Cite This Article:
Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181-184.
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