Pressure on the tracheal mucosa from cuffed tubes

Area of Science:

• Medical Devices
• Anesthesiology
• Critical Care Medicine

Background:

• Tracheal damage during intubation is a significant clinical concern.
• Cuff-induced tracheal injury is primarily influenced by lateral wall pressure.
• Maintaining cuff pressure below mucosal capillary perfusion pressure is crucial for preventing damage.

Purpose of the Study:

• To evaluate the lateral wall pressure exerted by different endotracheal tube cuffs.
• To compare cuff pressures of various endotracheal tubes at seal point and during overinflation.
• To identify endotracheal tubes that minimize the risk of tracheal damage.

Main Methods:

• Eight different types of endotracheal tubes were tested.
• Lateral wall pressure was measured at the seal point and during overinflation.
• Pressures were compared against mean systemic arterial pressure and mean capillary perfusion pressure.

Main Results:

• Traditional red rubber, armoured latex, and Softway tubes exceeded mean systemic arterial pressure at seal point.
• Portex and Mallinckrodt tubes showed high pressures upon overinflation.
• The Lanz tube maintained safe pressures even when significantly overinflated.

Conclusions:

• Endotracheal cuff overinflation is common in clinical practice.
• Lanz-type tubes, with their safety balloon, effectively maintain low lateral wall pressure.
• Mandatory use of Lanz-type tubes in intensive care and for cuffed tracheostomies is suggested, with consideration for routine anesthesia.