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Factors affecting leak around tracheal tubes in children

D A Finholt, D B Henry, R C Raphaely

    Canadian Anaesthetists' Society Journal
    |July 1, 1985
    PubMed

    Insights

    Endotracheal tube "leak" pressure in pediatric surgical patients varies significantly with head position and neuromuscular blockade. Maintaining full paralysis and neutral head position ensures reliable leak pressure measurements.

    Area of Science:

    • Anesthesiology
    • Pediatric Surgery
    • Respiratory Physiology

    Background:

    • Accurate measurement of endotracheal tube (ETT) leak pressure is crucial for patient safety during mechanical ventilation.
    • Uncuffed ETTs are commonly used in pediatric patients, necessitating careful monitoring of air leaks.
    • Variability in leak pressure can impact ventilation strategies and patient outcomes.

    Purpose of the Study:

    • To identify factors influencing endotracheal tube "leak" pressures in pediatric surgical patients.
    • To establish a reliable method for measuring ETT leak pressure in this population.

    Main Methods:

    • Prospective study involving 80 pediatric surgical patients (2 weeks to 11 years) intubated with uncuffed ETTs.
    • Leak pressure was measured by assessing the inspiratory pressure required to produce an audible air leak around the ETT.
    • Variables tested included head position, ETT depth, fresh gas flow rate, and degree of neuromuscular blockade.

    Main Results:

    • Leak pressure significantly increased with recovery from neuromuscular blockade (16.9 cmH2O with paralysis to 30.6 cmH2O with full recovery).
    • Turning the head from neutral to lateral position increased leak pressure (14.7 cmH2O to 24.4 cmH2O).
    • ETT depth and fresh gas flow rate did not significantly affect leak pressure.

    Conclusions:

    • Head position and neuromuscular blockade status are critical determinants of ETT leak pressure in pediatric patients.
    • A consistent and reliable method for measuring leak pressure involves maintaining full neuromuscular blockade and a neutral head position.

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