Comparing adaptations from blood flow restriction exercise training using regulated or unregulated pressure systems: A systematic review and meta-analysis.

OBJECTIVE: No study has examined outcomes derived from blood flow restriction exercise training interventions using regulated compared with unregulated blood flow restriction pressure systems. Therefore, we used a systematic review and meta-analyses to compare the chronic adaptations to blood flow restriction exercise training achieved with regulated and unregulated blood flow restriction pressure systems. DATA SOURCES: The electronic database search included using the tool EBSCOhost and other online database search engines. The search included Medline, SPORTDiscus, CINAHL, Embase and SpringerLink. METHODS: Included studies utilised chronic blood flow restriction exercise training interventions greater than two weeks duration, where blood flow restriction was applied using a regulated or unregulated blood flow restriction pressure system, and where outcome measures such as muscle strength, muscle size or physical function were measured both pre- and post-training. Studies included in the meta-analyses used an equivalent non-blood flow restriction exercise comparison group. RESULTS: Eighty-one studies were included in the systematic review. Data showed that regulated (n = 47) and unregulated (n = 34) blood flow restriction pressure systems yield similar training adaptations for all outcome measures post-intervention. For muscle strength and muscle size, this was reaffirmed in the included meta-analyses. CONCLUSION: This review indicates that practitioners may achieve comparable training adaptations with blood flow restriction exercise training using either regulated or unregulated blood flow restriction pressure systems. Therefore, additional factors such as device quality, participant comfort and safety, cost and convenience are important factors to consider when deciding on appropriate equipment to use when prescribing blood flow restriction exercise training.

Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury.

OBJECTIVE: Assessment of the effect of continuous cuff pressure control on airway injury in middle-aged and elderly patients undergoing endoscopic submucosal dissection (ESD). METHOD: A total of 104 eligible middle-aged and elderly patients requiring esophageal ESD from July 2022-September 2023 at the First Affiliated Hospital of Nanchang University were selected and randomly divided into two groups: the group undergoing general anesthesia tracheal intubation with continuous control of cuff pressure after intubation (Group A, n = 51) and the group undergoing general anesthesia tracheal intubation with continuous monitoring without control of cuff pressure (Group B, n = 53). After endotracheal intubation in Group A, under the guidance of an automatic cuff pressure controller, the air was used to inflate the tracheal cuff until the cuff pressure was 25-30cmH2O. The cuff pressure after intubation was recorded, and then the cuff pressure parameters were directly adjusted in the range of 25-30cmH2O until tracheal extubation after the operation. After endotracheal intubation, patients in Group B inflated the tracheal cuff with clinical experience, then monitored and recorded the cuff pressure with a handheld cuff manometer and instructed the cuff not to be loosened after being connected to the handheld cuff manometer-continuous monitoring until the tracheal extubation, but without any cuff pressure regulation. The patients of the two groups performed esophageal ESD. The left recumbent position was taken before the operation, and the cuff's pressure was recorded. Then, insert the gastrointestinal endoscope to find the lesion site and perform appropriate CO2 inflation to display the diseased esophageal wall for surgical operation fully. After determining the location, the cuff pressure of the two groups was recorded when the cuff pressure was stable. After the operation, the upper gastrointestinal endoscope was removed and the cuff pressure of the two groups was recorded. Postoperative airway injury assessment was performed in both groups, and the incidence of sore throat, hoarseness, cough, and blood in sputum was recorded. The incidence of postoperative airway mucosal injury was also observed and recorded in both groups: typical, episodic congestion spots and patchy local congestion. RESULT: The incidence of normal airway mucosa in Group A was higher than that in Group B (P < 0.05). In comparison, the incidence of occasional hyperemia and local plaque congestion in Group A was lower than in Group B (P < 0.05). CONCLUSION: Continuous cuff pressure control during operation can reduce airway injury in patients with esophageal ESD and accelerate their early recovery after the operation.

Effect of cuff inflation with lidocaine, saline, and air on tracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms: a randomized clinical trial.

BACKGROUND: Tracheal tube cuff pressure will increase after pneumoperitoneum when the cuff is inflated with air, high pressure can cause tracheal mucosal damage. This prospective trial aimed to assess if inflating with normal saline or lidocaine can prevent increase of tracheal tube cuff pressure and tracheal mucosal damage in laparoscopic surgeries with general anesthesia. Whether changes of tracheal tube cuff transverse diameter (CD) can predict changes of tracheal tube cuff pressure. METHODS: Ninety patients scheduled for laparoscopic resection of colorectal neoplasms under general anesthesia were randomly assigned to groups air (A), saline (S) or lidocaine (L). Endotracheal tube cuff was inflated with room-temperature air in group A (n = 30), normal saline in group S (n = 30), 2% lidocaine hydrochloride injection in group L (n = 30). After intubation, tracheal tube cuff pressure was monitored by a calibrated pressure transducers, cuff pressure was adjusted to 25 cmH2O (T0.5). Tracheal tube cuff pressure at 15 min after pneumoperitoneum (T1) and 15 min after exsufflation (T2) were accessed. CD were measured by ultrasound at T0.5 and T1, the ability of ΔCD (T1-0.5) to predict cuff pressure was accessed. Tracheal mucous injury at the end of surgery were also recorded. RESULTS: Tracheal tube cuff pressure had no significant difference among the three groups at T1 and T2. ΔCD had prediction value (AUC: 0.92 [95% CI: 0.81-1.02]; sensitivity: 0.99; specificity: 0.82) for cuff pressure. Tracheal mucous injury at the end of surgery were 0 (0, 1.0) in group A, 0 (0, 1.0) in group S, 0 (0, 0) in group L (p = 0.02, group L was lower than group A and S, p = 0.03 and p = 0.04). CONCLUSIONS: Compared to inflation with air, normal saline and 2% lidocaine cannot ameliorate the increase of tracheal tube cuff pressure during the pneumoperitoneum period under general anesthesia, but lidocaine can decrease postoperative tracheal mucosa injury. ΔCD measured by ultrasound is a predictor for changes of tracheal tube cuff pressure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session.

Introduction: Accurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses. Methods: This prospective longitudinal interventional study was performed among registered nurses at the emergency departments in a Johannesburg Academic Hospital. The study aimed to determine their current knowledge and practical skills on endotracheal tube cuff manometry and assess the effectiveness of a training program. The training program was provided once, in the form of a narrated PowerPoint presentation developed by the researchers and involved theoretical and practical components. The participants' theoretical knowledge and practical skills were measured by using questionnaires and skill assessments. The theoretical and practical scores were compared pre- and post-training. Results: Of the 63 registered nurses employed in the emergency departments, 95 % (60) participated in this study. 86 % reported having never received any formal training on endotracheal tube cuff manometry. Only 38.9 % used cuff manometry as standard practice and only 12.8 % checked it at appropriate 12-hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8 % and post-training of 64.5 % (p = 0.001).The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1 % and a post-training average of 93.3 % (p = 0.001). Conclusion: This study showed inadequate knowledge and skills on endotracheal cuff pressure manometry among registered nurses in the emergency department. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training.

Risk factor evaluation of cuff pressure of >30 cmH2O to stop air leakage during mechanical ventilation: A prospective observational study.

AIM: The commonly recommended endotracheal tube cuff pressure is 20-30 cmH2O. However, some patients require a cuff pressure of >30 cmH2O to prevent air leakage. The study aims to determine the risk factors that contribute to the endotracheal tube cuff pressure of >30 cmH2O to prevent air leakage. DESIGN: A multi-centre prospective observational study. METHODS: Eligible patients undergoing mechanical ventilation in the intensive care unit of three hospitals between March 2020 and July 2022 were included. The endotracheal tube cuff pressure to prevent air leakage was determined using the minimal occlusive volume technique. The patient demographics and clinical information were collected. RESULTS: A total of 284 patients were included. Among these patients, 55 (19.37%) patients required a cuff pressure of >30 cmH2O to prevent air leakage. The multivariate logistic regression results revealed that the surgical operation (odds ratio [OR]: 8.485, 95% confidence interval [CI]: 1.066-67.525, p = 0.043) was inversely associated with the endotracheal tube cuff pressure of >30 cmH2O, while the oral intubation route (OR: 0.127, 95% CI: 0.022-0.750, p = 0.023) and cuff inner diameter minus tracheal area (OR: 0.949, 95% CI: 0.933-0.966, p < 0.001) were negatively associated with the endotracheal tube cuff pressure of >30 cmH2O. Therefore, a significant number of patients require an endotracheal tube cuff pressure of ＞30 cmH2O to prevent air leakage. Several factors, including the surgical operation, intubation route, and difference between the cuff inner diameter and tracheal area at the T3 vertebra, should be considered when determining the appropriate cuff pressure during mechanical ventilation.

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial.

BACKGROUND: Postoperative sore throat (POST) is a common complication following endotracheal tube removal, and effective preventive strategies remain elusive. This trial aimed to determine whether actively regulating intraoperative cuff pressure below the tracheal capillary perfusion pressure threshold could effectively reduce POST incidence in patients undergoing gynecological laparoscopic procedures. METHODS: This single-center, randomized controlled superiority trial allocated 60 patients scheduled for elective gynecological laparoscopic procedures into two groups: one designated for cuff pressure measurement and adjustment (CPMA) group, and a control group where only cuff pressure measurement was conducted without any subsequent adjustments. The primary outcome was POST incidence at rest within 24 h post-extubation. Secondary outcomes included cough, hoarseness, postoperative nausea and vomiting (PONV) incidence, and post-extubation pain severity. RESULTS: The incidence of sore throat at rest within 24 h after extubation in the CPMA group was lower than in the control group, meeting the criteria for statistically significant superiority based on a one-sided test (3.3% vs. 26.7%, P < 0.025). No statistically significant differences were observed in cough, hoarseness, or pain scores within 24 h post-extubation between the two groups. However, the CPMA group had a higher incidence of PONV compared to the control group. Additionally, the control group reported higher sore throat severity scores within 24 h post-extubation. CONCLUSIONS: Continuous monitoring and maintenance of tracheal tube cuff pressure at 18 mmHg were superior to merely monitoring without adjustment, effectively reducing the incidence of POST during quiet within 24 h after tracheal tube removal in gynecological laparoscopic surgery patients. TRIAL REGISTRATION: The study was registered at www.chictr.org.cn (ChiCTR2200064792) on 18/10/2022.

Associations between cognitive test scores and pain tolerance: The Tromsø study.

OBJECTIVES: Previous studies have suggested that experimental pain sensitivity is associated with cognitive function. The aim of this study is to assess this relationship in a large population-based sample. METHODS: We included 5,753 participants (aged 40-84 years) from the seventh wave of the population-based Tromsø Study who had been examined with cognitive tests and experimental pain assessments, and for whom information on covariates were available. Cox regression models were fitted using standardized scores on cognitive tests (12-word immediate recall test, digit symbol coding test, and Mini-Mental State Examination [MMS-E]) as the independent variable and cold pressor or cuff pressure pain tolerance as the dependent variables. Statistical adjustment was made for putative confounders, namely, age, sex, education, smoking, exercise, systolic blood pressure, body mass index, symptoms indicating anxiety or depression, analgesic use, and chronic pain. RESULTS: In multivariate analysis, cold pressor tolerance time was significantly associated with test scores on the 12-word immediate recall test (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90-0.97, p < 0.001), the digit symbol coding test (HR 0.94, 95% CI 0.89-0.98, p = 0.004), and the MMS-E (HR 0.93, 95% CI 0.90-0.96 p < 0.001). Tolerance to cuff pressure algometry was significantly associated with 12-word immediate recall (HR 0.94-0.97, p < 0.001) and Digit Symbol Coding test scores (HR 0.93, 95% CI 0.89-0.96, p < 0.001) while there was no significant association with Mini Mental State Examination test score (HR 0.98, 95% CI 0.95-1.00, p = 0.082). CONCLUSION: Lower pain tolerance was associated with poorer performance on cognitive tests.

The effect of different endotracheal tube cuff pressure monitoring systems on postoperative sore throat in patients undergoing tracheal intubation: a randomized clinical trial.

BACKGROUND: Postoperative sore throat (POST) is an unpleasant outcome that can occur as a result of tracheal intubation in adults. Increased pressure from the endotracheal tube (ETT) cuff often leads to local mucosal injury, resulting in sore throat. The purpose of this study was to compare the effect of two different ETT cuff pressure monitoring systems vs. no cuff pressure monitoring on the incidence and severity of POST in adults. METHODS: One hundred and fourteen ASA I-III patients of either gender, aged 18-65 years, and undergoing surgery requiring endotracheal intubation were included in this study. Patients were randomized into three groups: control (C), cuff pressure gauge (G), and automated cuff controller (A). The ETT cuff pressure was not monitored intraoperatively in group C but was monitored using a cuff pressure gauge and an automated cuff controller in groups G and A, respectively. Postoperatively, patients were assessed at 2, 24, and 48 h for the presence and severity of POST, hoarseness and cough. RESULTS: One hundred and eleven patients completed the study. POST occurred in 40.5% of the patients in group G (n = 37) (p = 0.013) and 23.7% of the patients in group A (n = 38) (p < 0.001) within 48 h after surgery, compared to 69.4% in group C (n = 36). There were no significant differences in hoarseness, coughing, and dysphagia across the groups at any time. When comparing groups A and C, individuals in group A exhibited a lower occurrence of significant (grade ≥ 2) POST and hoarseness (10.5% vs. 41.7%, p = 0.002; 26.3% vs. 58.3%, p = 0.005). The incidence of significant cough and dysphagia did not differ substantially across the patient groups within 48 h after surgery. POST scores in group A at 2, 24 h postoperatively were both 0 (0-0), which was significantly lower than those in group C (1 (0-2) at 2 h, p < 0.001 ; 1 (0-1) at 24 h, p = 0.001). POST in group G at 2 h postoperatively was graded as 0 (0-1.5) which was milder than group C (P = 0.024). The severity of hoarseness in group A with scores of 0 (0-2) was superior to that in group C (2 (0-2), p = 0.006) at 2 h postoperatively. CONCLUSIONS: In conclusion, the findings of this study indicated that the occurrence of POST can be reduced by using either the cuff pressure gauge approach or the automated cuff controller method. The automated cuff controller monitoring can potentially decrease the severity of POST and hoarseness. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Endotracheal Cuff-pressure Monitoring in ICU: A Standard of Care Yet to be Standardized, and Often Neglected.

How to cite this article: Kumar AKA. Endotracheal Cuff-pressure Monitoring in ICU: A Standard of Care Yet to be Standardized, and Often Neglected. Indian J Crit Care Med 2024;28(1):8-10.

Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study.

Aims and background: Endotracheal tube cuff pressure (ETCP) is an important factor to determine the development of complications associated with invasive mechanical ventilation. To avoid preventable complications arising out of immobilization, frequent changes in body positioning are necessary. Such variations in body position can affect ETCP in critically ill patients who are on mechanical ventilation. So, our study aimed to assess the effect of changes in body position on ETCP in patients who are on mechanical ventilation. Materials and methods: This prospective observational study included 31 critically ill intubated patients. Each study subject was first placed in a neutral starting position with a 30º head elevation. Then, they were subjected to a sequential change in body position based on the 16 most used positions as part of the critical care unit's (CCUs) daily routine. Endotracheal tube cuff pressure was measured after each position change. Data were analyzed using standard statistical tests. Results: Statistically significant difference in ETCP was observed during anteflexion of neck, hyperextension of neck, left lateral flexion of neck, right lateral flexion of neck, left lateral rotation of neck, right lateral rotation of neck, 10o recumbent position, supine position, Trendelenburg position, and right lateral 30° and 45° positions. Maximum increase in ETCP was seen during anteflexion of neck (31 ± 4.5; 22-42 cm H2O). Conclusion: Our study demonstrates significant deviations in ETCP from the recommended range following changes in the body position of mechanically ventilated patients, highlighting the need for the measurement of ETCP after each position change and maintenance of the same within the target range. How to cite this article: Roy O, Dasgupta S, Chandra A, Biswas P, Choudhury A, Ghosh S, et al. Relationship of Endotracheal Tube Cuff Pressures with Changes in Body Positions of Critically Ill Patients on Mechanical Ventilation: An Observational Study. Indian J Crit Care Med 2024;28(1):36-40.

The Effect of Topical Benzydamine Hydrochloride and Cuff Pressure Monitorization on Postoperative Sore Throat Due to Intubation.

OBJECTIVE: Postoperative sore throat (POST) is the most common discomfort after endotracheal intubation. Damage to the tracheal mucosa caused by inappropriate endotracheal tube (ETT) cuff pressure has been shown as the major factor. Monitoring the ETT cuff pressure at a certain value reduces this damage. Benzydamine hydrochloride (BH) has proven to be effective on sore throat and studies have shown that it is also effective on POST. In this study, the efficacy of BH and ETT cuff pressure monitoring on POST was evaluated. MATERIALS AND METHODS: After ethics committee approval 210 patients in the ASA (American Society of Anesthesiologists) I-III risk group undergoing elective surgery were included in the study. Routine anesthesia monitoring, induction, and maintenance were provided. Patients were randomly divided into three groups. Thirty minutes before surgery, the posterior pharyngeal wall was sprayed with BH in group 1 and distilled water in groups 2 and 3. Intraoperatively, the first and second groups were monitored to keep the ETT cuff pressure between 22 and 26 cmH2O, while no intervention was performed in the third group. The incidence and severity of postoperative dysphagia, hoarseness, and POST were questioned. RESULTS: There was no difference between demographic data, and gender was not associated with POST. There was a statistically significant difference between the first and second groups and the third group in terms of all three symptoms questioned (p<0.01). No difference was observed between the first and second groups. Side effect rates were similar. Smoking was not found to be associated with symptoms. CONCLUSION: The incidence and severity of POST, dysphagia, and hoarseness are reduced when the ETT cuff is inflated with a pressure of 22-26 cmH2O after intubation with a manometer and maintained at this pressure range throughout the operation. There was no beneficial effect of BH.

Measurements of Electrodermal Activity, Tissue Oxygen Saturation, and Visual Analog Scale for Different Cuff Pressures.

The quantification of comfort in binding parts, essential human-machine interfaces (HMI) for the functioning of rehabilitation robots, is necessary to reduce physical strain on the user despite great achievements in their structure and control. This study aims to investigate the physiological impacts of binding parts by measuring electrodermal activity (EDA) and tissue oxygen saturation (StO2). In Experiment 1, EDA was measured from 13 healthy subjects under three different pressure conditions (10, 20, and 30 kPa) for 1 min using a pneumatic cuff on the right thigh. In Experiment 2, EDA and StO2 were measured from 10 healthy subjects for 5 min. To analyze the correlation between EDA parameters and the decrease in StO2, a survey using the visual analog scale (VAS) was conducted to assess the level of discomfort at each pressure. The EDA signal was decomposed into phasic and tonic components, and the EDA parameters were extracted from these two components. RM ANOVA and a post hoc paired t-test were used to determine significant differences in parameters as the pressure increased. The results showed that EDA parameters and the decrease in StO2 significantly increased with the pressure increase. Among the extracted parameters, the decrease in StO2 and the mean SCL proved to be effective indicators. Such analysis outcomes would be highly beneficial for studies focusing on the comfort assessment of the binding parts of rehabilitation robots.

Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

OBJECTIVE: This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. METHODS: Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. RESULTS: We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). CONCLUSION: Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Fiabilidad del control de presión del neumotaponamiento del tubo endotraqueal por el método de palpación digital en el Centro Médico Teknon / Reliability of palpation-based endotracheal cuff pressure assessment in Centro Médico Teknon

Introducción:La presión del neumotaponamiento no es estrictamente controlada durante las intervenciones quirúrgicas. La medición objetiva se reemplaza por la medición mediante dígito-palpación, inexacta y con tendencia a la hiperinsuflación. Ésta genera complicaciones postoperatorias (dolor, tos y ronquera). El objetivo del estudio es evaluar la fiabilidad del inflado del neumotaponamiento por digito-palpación realizado por personal experto. Material y métodos:Se realizó un estudio descriptivo transversal en pacientes operados electivamente en nuestro centro bajo anestesia general e intubación endotraqueal, entre octubre y diciembre de 2020. Se incluyeron 138 pacientes. Se registraron parámetros biométricos y el inflado del neumotaponamiento por dígito-palpación de personal experto, y se comparó con medición por manómetro para ajuste siempre a una presión estandarizada (30 cm H2O). Se midió con manómetro la presión al final del procedimiento, y se analizó su variación respecto a la inicial y su relación con posición quirúrgica, duración de intervención y diámetro del tubo endotraqueal. Resultados:La distribución de la presión inicial medida por manómetro muestra tendencia al sobreinflado de la estimación por dígito-palpación, con coeficiente de correlación kappa de 0,6. La variable presión final por manómetro muestra tendencia a la pérdida de presión respecto a la inicial estandarizada. No se encuentra relación estadísticamente significativa entre presión final por manómetro y posición quirúrgica, tamaño de tubo o tiempo quirúrgico (aunque en cirugías de más de 3 horas la presión final es claramente inferior al resto). (AU)

Introduction:Endotracheal cuff pressure is not routinely controlled during surgical interventions. Objective measurements are replaced by palpation-based estimations which are inexact and tending to hyperinsuflation. This causes postoperative complications (throat pain, coughing and hoarseness). The aim of this study is evaluating the reliability of endotracheal cuff pressure assessed by palpation of expertise clinicians. Materials and methods:A transversal descriptive study was performed in patients electively operated under general anaesthesia and endotracheal intubation in our hospital between October and December 2020. 138 patients were included. Biometric parameters and cuff palpation-based pressure were registered. It was compared to manometer-based pressure measurement and adjusted in all cases to a standardized pressure (30 cm H2O). Final procedure pressure was also measured with manometer, and its relationship with initial pressure and surgical position, intervention length and endotracheal tube diameter was analysed. Results:Initial manometer-based pressure measurement shows palpation-based measurement tends to hyperinsuflation, with a 0,6 kappa correlation coefficient. Manometer-based final cuff pressure shows tendency to decrease when compared to initial standardised pressure. No statistically significant relationship was found between final cuff pressure and surgical position, tube diameter or intervention length (even though interventions above 3 hours show significantly inferior final pressure values). (AU)

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study / Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Abstract Background and objectives: Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital. Methods: Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon. Results: Forty-seven anesthesiologists were included in the study - 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases. Conclusion: The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Resumo Justificativa e objetivos: O controle inadequado da pressão dos balonetes dos tubos traqueais pode resultar em complicações. A técnica objetiva com uso de manômetro é a recomendada para manutenção de valores seguros de pressão (20-30 cm H2O). Mas como ese instrumento é pouco disponível, os anestesiologistas recorrem a técnicas subjetivas. O objetivo deste estudo foi avaliar a adequação da técnica subjetiva para obtenção das pressões dos balonetes e o nível de experiência com uso do manômetro entre médicos especialistas e residentes de anestesiologia de um Hospital Universitário. Método: Estudo observacional prospectivo, com participantes que realizaram intubação traqueal e técnica subjetiva para insuflação dos balonetes. Pacientes com via aérea difícil, anormalidades anatômicas de laringe e traqueia, risco de broncoaspiração e os casos de emergência não foram incluídos. Até 60 minutos após a intubação, um investigador registrava a pressão do balonete utilizando um manômetro aneroide (AMBU®) conectado ao balonete guia do tubo. Resultados: Quarenta e sete anestesiologistas foram incluídos no estudo - 24 residentes e 23 especialistas. As pressões (cm H2O) média (DP) e mediana (IQR) encontradas foram, respectivamente, 52,5 (27,1) e 50 (30-70). Da amostra, 83% estavam fora da faixa adequada de pressão, sem diferença entre especialistas e residentes. O nível de experiência com a técnica objetiva também foi semelhante entre os grupos. Correção da pressão foi realizada em 76,6% dos casos. Conclusões: A técnica subjetiva para insuflar os balonetes dos tubos traqueais resultou em alta prevalência de pressões inadequadas, sem diferença no desempenho entre especialistas e residentes.

Application study on improving the methods of endotracheal cuff pressure measurement to prevent ventilator-associated pneumonia / 中华危重病急救医学

To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. Methods① Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.② Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. Results ① Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. ② Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.

Study on the pressure change of cuff in the tapered-cuff endotracheal tubes in patients with trachea intubation / 现代临床护理

Objective To investigate the pressure changes of cuff in the tapered-cuff endotracheal tubes and the frequency of cuff pressure monitoring in patient with trachea intubation. Methods From December 2016 to October 2017, 80 patients with oral tracheal intubation in the emergency department were divided into group A (n =25) and group B (n =23) according to the principle of randomized control. Group A with odd number was treated and tapered-cuff endotracheal tubes and group B with ever number and cylindrical-cuff endotracheal tubes. Continuous cuff pressure monitoring device was used to continuously monitor the cuff pressure. The two groups were compared in terms of time for keeping the normal cuff pressure and cuff pressure (average pressure, maximum pressure and minimum pressure). Results The total time for keeping the normal cuff pressure in group A was significantly shorter than that in group B (P＜0.05). The average cuff pressure in group A was smaller than that of group B (P＜0.05). The maximum pressure in group A is larger than that in group B and the maximum cuff pressure in group A was smaller than that of group B (P＜0.05). Conclusion Compared with the cylindrical cuff catheter, the tapered-cuff tube can maintain the normal pressure for a shorter period and easily produce needed pressure. It is a need to enhance the monitoring of cuff pressure to ensure good airway closure and reduce artificial airway complications.

Post-operative Sore Throat: Comparing the Monitored Endotracheal Tube Cuff Pressure and Pilot Balloon Palpation Methods

@#Background: Endotracheal tube cuff (ETTc) inflation pressure is usually not regarded as an important aspect during intubation. In this study, we compared measuring ETTc pressure and pilot balloon palpation method in causing post-operative airway complications. Methods: Two hundred and ninety-two surgical patients requiring intubation were recruited into this prospective, double-blind, randomised controlled study. Group A patients had their ETTc initially inflated, checked by a cuff pressure gauge, recorded and then set to 25 cmH2O. Group B patients had their ETTc inflated using the pilot balloon palpation method. Patients were then followed up for post-operative sore throat, hoarseness and cough. Results: The overall incidence of post-operative sore throat was 39.0% versus 75.3% (P < 0.001), hoarseness 6.2% versus 15.1% (P < 0.05) and cough 7.5% versus 21.9% (P < 0.05) in Group A and B, respectively. Group A patients experienced a significant reduction in the incidence and severity of sore throat up to 24 h post-operatively (P < 0.001), hoarseness at the first hour (P = 0.004) and cough at first and 12 h post-operatively (P = 0.002). Conclusion: Adjusting the ETTc pressure to 25 cmH2O reduces post-operative sore throat, hoarseness and cough compared to pilot balloon palpation method.

Monitoreo de presión de manguito de tubo endotraqueal / Monitoring endotracheal tube cuff pressure

OBJECTIVE: Perform an objective monitoring of the endotracheal tube cuff pressure in patients under general anesthesia in the Anesthesiology Service of Hospital Privado de Córdoba. METHODS: It is a controlled, comparative, prospective study where the range of cuff pressures was analyzed at the beginning and end of surgery. A Rush brand manometer (Endotest) was used to perform the measurement. This pressure was related to the patient's data (sex, age, BMI, duration of surgery, endotracheal tube diameter). RESULTS: The total sample was 74 patients, and an initial inflation pressure outside the normal range was found in 75.7 percent of the patients of which 48.6 percent was out of the normal range and 27 percent was below of the normal range. At the end of the surgery it was found that 81.8 percent was within normal values. CONCLUSION: It is mandatory to monitor endotracheal tube cuff pressure in patients under general anesthesia.

OBJETIVOS: Realizar un monitoreo de forma objetiva de la presión del manguito de tubo endotraqueal en los pacientes bajo anestesia general en el servicio de Anestesiología del Hospital Privado de Córdoba. MATERIAL Y MÉTODOS: Es un estudio controlado, comparativo, prospectivo donde se analizo el rango de presiones del manguito al inicio y al final de la cirugía. Se utilizo un manometro de marca Rush (Endotest) para realizar la medición. Esta presión se la relaciono con los datos del paciente (sexo, edad, IMC, duración de cirugía, diámetro de tubo endotraqueal). RESULTADOS: El total de la muestra fueron 74 pacientes, y se encontró una presión de inflado inicial fuera de rango normal en un 75,7 por ciento, de los cuales un 48,6 por ciento fue elevado y un 27 por ciento por debajo del rango normal. Al final de la cirugía se comprobó que el 81,8 por ciento estaba dentro de valores normales. CONCLUSIÓN: Es mandatorio el monitoreo de presión del manguito del tubo endotraqueal en todos los pacientes bajo anestesia general.

Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in anesthetic gases during laparoscopic abdominal surgeries / Comparação de alterações na pressão do balonete do tubo endotraqueal usando ar versus óxido nitroso nos gases anestésicos durante cirurgias abdominais laparoscópicas

Abstract Background and objectives The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in anesthetic gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. Methods Total 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n = 50) received air while Group N (n = 50) received nitrous-oxide in anesthetic gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30 min, 60 min and 90 min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24 h after extubation. Results Cuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p < 0.001). Within Group A, cuff pressure increased more at 90 min than at 30 min (p < 0.05). Within Group N, increase in cuff pressure was more at each time point (30, 60 and 90 min) than its previous time point (p < 0.05). The incidence of sore throat in post-anesthesia care unit was higher in Group N than in Group A. Conclusion Use of nitrous-oxide during laparoscopy increases cuff pressure resulting in increased incidence of postoperative sore throat. Cuff pressure should be monitored routinely during laparoscopy with nitrous-oxide anesthesia.

Resumo Justificativa e objetivos O objetivo deste estudo foi comparar as alterações na pressão do balonete do tubo endotraqueal durante cirurgias laparoscópicas usando ar versus óxido nitroso na mistura dos gases anestésicos e observar a incidência de dor de garganta, rouquidão e disfagia no pós-operatório. Métodos No total, 100 pacientes agendados para cirurgia abdominal laparoscópica eletiva foram alocados em dois grupos: Grupo A (n = 50) recebeu ar e Grupo N (n = 50) recebeu óxido nitroso na mistura de gases anestésicos. Após a intubação endotraqueal, o balonete foi insuflado com ar para obter a pressão de vedação. As pressões do balonete na fase basal (pressão de vedação), aos 30 min, 60 min e 90 min foram registradas com um manômetro. A incidência de dor de garganta, rouquidão e disfagia foi observada no momento da alta da sala de recuperação pós-anestésica e 24 horas após a extubacão. Resultados A pressão do balonete aumentou em ambos os grupos, comparada à pressão basal. O aumento da pressão do balonete foi maior no Grupo N do que no Grupo A em todos os tempos avaliados (p < 0,001). No Grupo A, o aumento da pressão do balonete foi maior aos 90 min do que aos 30 min (p < 0,05). No Grupo N, o aumento da pressão do balonete foi maior em cada um dos tempos (30, 60 e 90 min) do que no tempo anteriormente mensurado (p < 0,05). A incidência de dor de garganta na sala de recuperação pós-anestésica foi maior no Grupo N do que no Grupo A. Conclusão O uso de óxido nitroso durante a laparoscopia aumenta a pressão do balonete, resulta em aumento na incidência de dor da garganta no pós-operatório. A pressão do balonete deve ser rotineiramente monitorada durante a laparoscopia sob anestesia com óxido nitroso.