Objective and Subjective Evaluation of Endotracheal Tube Cuff Pressure between Different Levels of Anesthesia Experiences

Yıl 2023, Cilt: 9 Sayı: 1, 39 - 42, 02.02.2023

Tülay Çardaközü , Elif Özge Çınar Köse , Nur Nazire Yucal , Sibel Balcı

https://doi.org/10.30934/kusbed.1144138

Öz

Objective: After endotracheal intubation (ETI), the endotracheal tube cuff (ETTc) should be inflated at sufficient pressure to function, and high pressure should be avoided to prevent complications. In our study, the effect of professional experience on the estimation of ETTcP by palpation is investigated.
Method: The study included 75 adult patients with physical status I-III of the American Society of Anesthesiology (ASA) scheduled for ETI. Anesthesia residents were divided into two groups of 20, each with 1 month to 1 year of experience (Group 1) and those with more than 4 years of experience (Group 2). After the ETI, one participant in both groups was asked to inflate the ETTc to an estimated 25 cm H2O by cuff palpation. Then the actual ETTcP was measured with a manometer.
Results: The median ETTcP value was 42,00 cm H2O in Group 1 and 32,00 cm H2O in Group 2, (p=0.012). Although the data of both groups were significantly higher than the target value, the values obtained in Group 1 were further away from Group 2 (p<0.001, p<0.001).
Conclusion: Professional experience has no effect on the correct estimation of the ETTcP. It is more convenient to measure the actual pressure to avoid undesirable effects of ETTcP outside the target.

Anahtar Kelimeler

Airway management, anesthesia assistants, endotracheal intubation, general anesthesia, mechanical ventilation, medical professionalism

Farklı Anestezi Deneyim Düzeyleri Arasında Endotrakeal Tüp Kaf Basıncının Objektif ve Subjektif Değerlendirilmesi

Öz

Amaç: Endotrakeal entübasyon (ETI) sonrası endotrakeal tüp kaf (ETTc), işlevini yerine getirebilmesi için yeterli basınçta şişirilmeli, komplikasyonları önlemek için ise yüksek basınçtan kaçınılmalıdır. Çalışmamızda mesleki deneyimin manuel palpasyonla endotrakeal tüp kaf basıncı (ETTcP) tahminine etkisi araştırılmaktadır.
Yöntem: Çalışmaya ETI planlanan, Amerikan Anesteziyoloji Derneği (ASA) fiziksel durumu I-III olan, 75 erişkin hasta dahil edildi. Anestezi asistanları 1 ay-1 yıl arasında deneyimi olanlar (Grup1) ve 4 yıldan fazla deneyimi olanlar (Grup 2) şeklinde 20'şer kişilik iki gruba ayrıldı. ETI sonrası, her iki gruptan da bir katılımcıdan ETTc'yi manuel kaf palpasyonu yöntemiyle tahminen 25 cm H2O' ya kadar şişirmesi istendi. Sonra ETTcP’nin gerçek değeri manometre ile ölçüldü.
Bulgular: Grup 1’ de median ETTcP değeri 42,00 cm H20, Grup 2 de 32,00 cm H20 idi (p=0.012). Her iki grubun verileri hedef değerden anlamlı derecede yüksek olmakla birlikte, Grup 1’de elde edilen değerler Grup 2’den daha uzaktı (p<0.001, p<0.001).
Sonuç: Mesleki deneyim ETTcP değerinin doğru tahmini üzerinde etkili değildir. Hedef değerin dışında ETTcP’nin istenmeyen etkilerini önlemek için gerçek basıncın ölçülmesi daha uygundur.

Anahtar Kelimeler

Havayolu yönetimi, anestezi asistanları, endotrakeal entübasyon, genel anestezi, mekanik ventilasyon, tıbbi mesleki deneyim

Kaynakça

• Henderson J. Airway management in the adult. In: Miller RD, Eriksson LI, Wiener-Kronish JP, Young WL, editors. Miller's Anesthesia. 7 th ed. Philadelphia: Churchill-Livingstone Elsevier; 2010:1573-1610.
• Knowlson GT, Bassett HF. The pressures exerted on the trachea by endotracheal inflatable cuffs. Br J Anaesth. 1970; 42(10): 834–837. doi:10.1093/bja/42.10.834.
• Lu YH, Hsieh MW, Tong YH. Unilateral vocal cord paralysis follow¬ing endotracheal intubation-a case report. Acta Anaesthesiol Sin. 1999;37(4):221–224. doi:10.1016/ j.ajem.2004.04.012.
• Fan CM, Ko PC, Tsai KC, et al. Tra¬cheal rupture complicating emergent endotracheal intubation. Am J Emerg Med. 2004;22(4):289-293. doi:10.1016/j.ajem.2004.04.012.
• Abbasidezfouli A, Shadmehr MB, Arab M, et al. Postintubation multisegmental tracheal stenosis: treatment and results. Ann Thorac Surg.2007;84(1):211-214. doi:10.1016/j.athoracsur.2007.03.050
• Kaur D, Anand S, Sharma P, Kumar A. Early presentation of pos¬tintubation tracheoesophageal fistula: Perioperative anesthetic management. J Anaesthesiol Clin Pharmacol. 2012;28(1):14-116. doi:10.4103/0970-9185.92460.
• Svenson JE, Lindsay MB, O'Connor JE. Endotracheal intracuff pressures in the ED and prehospital setting: is there a problem? Am J Emerg Med. 2007;25(1):53-56. doi:10.1016/ j.ajem.2006.09.001.
• Siamdoust S, Mohseni M, Memarian A. Endotracheal tube cuff pressure assessment: education may improve but not guarantee the safety of palpation technique. Anesth Pain Med. 2015;22;5(3): e16163. doi:10.5812/aapm.5(3)2015.16163.
• Ozer AB, Demirel I, Gunduz G, Erhan OL. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure. Niger J Clin Pract. 2013;16(2):253-257. doi:10.4103/1119-3077.110139.
• Saraçoğlu A, Dal D, Pehlivan G, Göğüş FY. The professional experience of anaesthesiologists in proper inflation of laryngeal mask and endotracheal tube cuff. Turk J Anaesthesiol Reanim. 2014;42(5):234-238. doi:10.5152/ TJAR.2014.87487.
• Hedberg P, Eklund C, Högqvist S. Identification of a Very High Cuff Pressure by Manual Palpation of the External Cuff Balloon on an Endotracheal Tube. AANA J. 2015; 83(3): 179-182. https://pubmed.ncbi.nlm.nih.gov/26137758/ Accessed August 10, 2021.
• Çolak A, Arar C, Şahin HS, Söker A, Günday A, Turan N. Is the anesthesiologist’s experience important while inflating the endotracheal tube cuff with the right pressure? J Clin Exp Invest. 2010;1(3):195-198. doi:10.5799/ahinjs.01.2010.03. 0040
• Gustavo AP, Nicolas R, Viviana F, et al. Evaluation of tracheal cuff pressure variation in spontaneously breathing patients. Int J Crit Illn Inj Sci. 2013;3(4):262-268. doi:10.4103/2229-5151.124148.
• Blanch PB. Laboratory evaluation of 4 brands of endotracheal tube cuff inflator. Respir Care. 2004; 49(2): 166–173. https://pubmed.ncbi.nlm.nih.gov/14744266/ Accessed August 10, 2021.
• Sengupta P, Sessler DI, Maglinger P, et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol. 2001;4(1):8-14. doi:10.1186/1471-2253-4-8.
• Li Bassi G, Ranzani OT, Marti JD, et al. An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures. Crit Care Med. 2013; 41(2): 518-526. doi:10.1097/CCM.0b013e31826a4804.
• Madjdpour C, Mauch J, Dave MH, Spielmann N, Weiss M. Comparison of air-sealing characteristics of tapered- vs. cylindrical-shaped high-volume, low-pressure tube cuffs. Acta Anaesthesiol Scand. 2012;56(2):230-235. doi:10.1111/j.1399-6576.2011.02542.x.
• Khalil ANS, Salama MRA, Mohammed WY, Sayed MS. Factors affecting endotracheal tube cuff pressure measurement: a review of literature. ARC Journal of Nursing and Healthcare. 2018;4(4):1-5. doi:10.20431/2455-4324.0404001
• Lizy C, Swinnen W, Labeau S, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care. 2014;23(1):1-8. doi:10.4037/ajcc2014489.
• Kumar CM, Seet E, Van Zundert TCRV. Measuring endotracheal tube intracuff pressure: no room for complacency. J Clin Monit Comput. 2021;35(1):3-10. doi:10.1007/s10877-020-00501-2
• Chan SM, Wong CS, Cherng CH. Determining an optimal tracheal tube cuff pressure by the feel of the pilot balloon: a training course for trainees providing airway care. Acta Anaesthesiol Taiwan. 2009;47(2):79-83. doi:10.1016/S1875-4597(09)60028-X.
• Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s Clinic Anaesthesiology. In: Butterworth JF, Wasnic JD, Mackey DC, editors. 6th ed. New York: McGraw-Hill Education; 2013:309-341.
• Rahmani F, Soleimanpour H, Zeynali A, et al. Comparison of tracheal tube cuff pressure with two techniques: fixed volume versus pilot balloon palpation. J Cardiovasc Thorac Res. 2017;9(4):196-199. doi:10.15171/jcvtr.2017.34.
• 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(6): 443–447. https://pubmed.ncbi.nlm.nih.gov/15098531/ Accessed August 10, 2021.
• Trivedi L, Jha P, Bajiya NR, Tripathi D. We should care more about intracuff pressure: The actual situation in government sector teaching hospital. Indian J Anaesth. 2010;54(4):314-317. doi:10.4103/0019-5049.68374.
• Turan A, Tükenmez B, Karamanlıoğlu B, Süt N, Pamukçu Z. Peroperatif kanama değerlendirilmesinde bir model: Anestezist-cerrah ve deneyim farkı. Turkiye Klinikleri J Anest Reanim. 2004;2(1):12-16. https://www.turkiyeklinikleri.com/ article/en-peroperatif-kanama-degerlendirilmesinde-bir-model-anestezist-cerrah-ve-deneyim-farki-35621.html Accessed August 10, 2021.
• Congreve K, Gardner I, Laxton C, Scrutton M. Where is T5? A survey of anesthetists. Anesthesia. 2006;61(5):453-455. doi:10.1111/j.1365-2044.2006.04609.x.
• Wujtewicz MA, Sawicka W, Owczuk R, Dylczyk Sommer A, Wujtewicz M. Tracheal tube cuff pressure depends on the anaesthesiologist’s experience. A follow up study. Anestezjol Intens Ter. 2009;41(4):205-208. https://pubmed.ncbi.nlm. nih.gov/20201339/ Accessed August 10, 2021.
• Danielis M, Benatti S, Celotti P, De Monte A, Trombini O. Continuous monitoring of endotracheal tube cuff pressure: best practice in the intensive care unit. Assist Inform Ric. 2015;34(1):15-20. doi:10.1702/1812.19746
• Koşar Ö, Şen Ö, Toptaş M, et al. Effect of nitrous oxide anesthesia on endotracheal cuff pressure. Med Bull Haseki. 2017;55:37-41. doi:10.4274/haseki.3168