Evaluation of tracheal cuff pressure variation in spontaneously breathing patients

Gustavo A Plotnikow, Nicolas Roux, Viviana Feld, Emiliano Gogniat, Dario Villalba, Noelia Vairo Ribero, Marisa Sartore, Mauro Bosso, Corina Quiroga, Valeria Leiva, Mariana Scrigna, Facundo Puchulu, Eduardo Distéfano, Jose Luis Scapellato, Dante Intile, Fernando Planells, Diego Noval, Pablo Buñirigo, Ricardo Jofré, Ernesto Díaz Nielsen, Gustavo A Plotnikow, Nicolas Roux, Viviana Feld, Emiliano Gogniat, Dario Villalba, Noelia Vairo Ribero, Marisa Sartore, Mauro Bosso, Corina Quiroga, Valeria Leiva, Mariana Scrigna, Facundo Puchulu, Eduardo Distéfano, Jose Luis Scapellato, Dante Intile, Fernando Planells, Diego Noval, Pablo Buñirigo, Ricardo Jofré, Ernesto Díaz Nielsen

Abstract

Background: Most of the studies referring cuff tubes' issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation.

Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center.

Materials and methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry.

Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings.

Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently.

Keywords: Artificial airway; cuff pressure; decannulation; prolonged mechanical ventilation; tracheostomy; ventilator-associated pneumonia.

Conflict of interest statement

Conflict of Interest: No.

Figures

Figure 1
Figure 1
CP variation in 1 day. CI (confidential interval) 95% P > 0.05
Figure 2
Figure 2
CP variation over 1 day for each of the tracheostomy tube brands. CI 95% P > 0.05
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3891193/bin/IJCIIS-3-262-g006.jpg

References

    1. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.
    1. Bernhard WN, Yost L, Joynes D, Cothalis S, Turndorf H. Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics. Chest. 1985;87:720–5.
    1. Diaz E, Rodríguez AH, Rello J. Ventilator-associated pneumonia: Issues Related to the artificial airway. Respir Care. 2005;50:900–6.
    1. Rello J, Soñora R, Jubert P, Artigas A, Rué M, Vallés J. Pneumonia in intubated patients: Role of respiratory airway care. Am J Respir Crit Care Med. 1996;154:111–5.
    1. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999;340:627–34.
    1. Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: A randomized trial. Crit Care Med. 2007;35:1543–9.
    1. Bishop MJ. Mechanisms of laryngotracheal injury following prolonged tracheal intubation. Chest. 1989;101:185–6.
    1. Vyas D, Inweregbu K, Pittard A. Measurement of tracheal tube cuff pressure in critical care. Anaesthesia. 2002;57:275–7.
    1. Braz JR, Navarro LH, Takata IH, Nascimento P., Júnior Endotracheal tube cuff pressure: Need for precise measurement. Sao Paulo Med J. 1999;117:243–7.
    1. Blanch PB. Laboratory evaluation of 4 brands of endotracheal tube cuff inflator. Respir Care. 2004;49:166–73.
    1. Tyler DO, Clark AP, Ogburn-Russell L. Developing a standard for endotracheal tube cuff care. Dimens Crit Care Nurs. 1991;10:54–61.
    1. Crimlisk JT, Horn MH, Wilson DJ, Marino B. Artificial airways: A survey of cuff management practices. Heart Lung. 1996;25:225–35.
    1. Sole ML, Byers JF, Ludy JE, Ostrow CL. Suctioning techniques and airway management practices: Pilot study and instrument evaluation. Am J Crit Care. 2002;11:363–8.
    1. Sole ML, Byers JF, Ludy JE, Zhang Y, Banta CM, Brummel K. A multisite survey of suctioning techniques and airway management practices. Am J Crit Care. 2003;12:220–30.
    1. Mehta S, Mickiewicz M. Pressure in large volume, low pressure cuffs: Its significance, measurement and regulation. Intensive Care Med. 1985;11:267–72.
    1. Torres A, El-Ebiary M, Soler N, Montón C, Fàbregas N, Hernández C. Stomach as a source of colonization of the respiratory tract during mechanical ventilation: Association with ventilator-associated pneumonia. Eur Respir J. 1996;9:1729–35.
    1. Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation. J Bras Pneumol. 2008;34:294–7.
    1. Inoue S, Takauchi Y, Kuro M, Ninaga H. Effects of changes in head and neck position on a tracheal tube cuff. Masui. 1998;47:1069–72.
    1. Sole ML, Aragon D, Bennett M, Johnson RL. Continuous measurement of endotracheal tube cuff pressure: How difficult can it be? ACCN Adv Crit Care. 2008;19:235–43.
    1. Farré R, Rotger M, Ferre M, Torres A, Navajas D. Automatic regulation of the cuff pressure in endotracheally intubated patients. Eur Respir J. 2002;20:1010–3.
    1. Sole ML, Penoyer DA, Su X, Jimenez E, Kalita SJ, Poalillo E, et al. Assessment of endotracheal cuff pressure by continuous monitoring: A pilot study. Am J Crit Care. 2009;18:133–43.
    1. O’Donnell JH. Endotracheal tube intra-cuff pressure initially and during anesthesia including nitrous oxide. CRNA. 1995;6:79–85.
    1. Hess DR. Managing the artificial airway. Respir Care. 1999;44:759–71.
    1. Fernandez R, Blanch L, Mancebo J, Bonsoms N, Artigas A. Endotracheal tube cuff pressure assessment: Pitfalls of finger estimation and need for objective measurement. Crit Care Med. 1990;18:1423–6.
    1. Stewart SL, Secrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003;71:443–7.
    1. Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, et al. Endotracheal tube cuff pressure in three hospitals, and the volumen required to produce an appropriate cuff pressure. BMC Anesthesiol. 2004;4:8.
    1. Mallampati SR. Airway management. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical Anesthesia. Philadelphia: Lippincott-Raven; 1997. pp. 583–5.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner