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Minimal Occlusive Pressure with Cuffed Endotracheal Tubes: A Comparison of Two Different Techniques to Ensure a Tracheal Seal

DiFranco, James Michael

Abstract Details

2016, Master of Science, Ohio State University, Dentistry.
Introduction: There has been an increased use of cuffed endotracheal tubes in the pediatric population among pediatric anesthesiologists, dentist anesthesiologists, and pediatric critical care physicians. The biggest concern with the use of cuffed endotracheal tubes in this population is the potential for compromising tracheal mucosal blood flow resulting fom pressure transmitted from the cuff to the tracheal wall. To date there are several techniques employed to guide cuff inflation in order to establish a tracheal seal and avoid generating intracuff pressures exceeding mean tracheal mucosal perfusion pressures. There are, however, few reports in the literature of actual cuff pressures generated from this routine practice, and even fewer comparative studies. This in vitro study compares intracuff pressures generated from a commonly used inflation technique, the air leak test, to a less commonly used technique involving tidal volume analysis. Methods: A 1-liter test lung apparatus was used to simulate a human lung with normal compliance (Respironics California, Inc, 2271 Cosmos Court,Carlsbad ,CA. 92011 USA). An appropriately sized endotracheal tube based on the internal diameter of the simulated trachea was used for the primary experimental settings. The tidal volume delivered during mechanical ventilation was selected based on a normal expected percentage of total lung capacity in a clinical scenario. The two cuff inflation techniques were performed and the intracuff pressures produced from each technique were measured directly using a standard invasive pressure monitoring system. Additional experimental variables included endotracheal tube size and delivered tidal volume. The difference between the intracuff pressures was evaluated using a paired t-test. A repeated-measures ANOVA was used to determine whether the difference in intracuff pressure following the application of each sealing technique varied across different experimental settings. Analyses were performed in Stata/IC 13.1 (College Station, TX: StataCorp, LP) and p<0.05 was considered statistically significant. Results: Ten trials were performed for each combination of cuffed endotracheal tube size (4.0 and 5.0) and delivered tidal volumes (100 mL and 200 mL) for a total of forty trials. The primary experimental settings of interest included using a 5.0 cuffed endotracheal tube and a delivered tidal volume of 100 ml based on the appropriate clinical parameters for the testing apparatus used. Using these settings, and establishing a clinically relevant target TVexp/TVinsp ratio of 0.9 to guide cuff inflation, the test group cuff pressure averaged 11.7 ± 8.9 mmHg compared to the air leak test group at 21.8 ± 11.1 mmHg. This difference was significant (p=0.006) with a 95% confidence interval ranging from 3.7 to 16.5 mmHg. Conclusion: The purpose of the in vitro portion of this study was to determine if further testing in the human subject model was both appropriate and necessary. The data suggests the tidal volume ratio technique to guide cuff inflation may produce lower mean intracuff pressures than when an air leak test is performed. Further testing of the tidal volume ratio technique as a guide to cuff inflation in the pediatric population is both safe, resulting in consistently lower cuff pressures, and warranted in the human population.
Simon Prior, BDS, PhD (Advisor)
Megann Smiley, DMD (Committee Member)
Joel Weaver, DDS, PhD (Committee Member)
Senthil Krishna, MD (Other)
40 p.

Recommended Citations

Citations

  • DiFranco, J. M. (2016). Minimal Occlusive Pressure with Cuffed Endotracheal Tubes: A Comparison of Two Different Techniques to Ensure a Tracheal Seal [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471012142

    APA Style (7th edition)

  • DiFranco, James. Minimal Occlusive Pressure with Cuffed Endotracheal Tubes: A Comparison of Two Different Techniques to Ensure a Tracheal Seal. 2016. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1471012142.

    MLA Style (8th edition)

  • DiFranco, James. "Minimal Occlusive Pressure with Cuffed Endotracheal Tubes: A Comparison of Two Different Techniques to Ensure a Tracheal Seal." Master's thesis, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1471012142

    Chicago Manual of Style (17th edition)