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Kraft BD, Goodman E, Sitler D, Fordson T, Gibson C, Samih N, Kumawat H, Wade P, Kollef MH. The Dilemma of Water-Filled Tracheostomy Tube Cuffs. Respir Care 2025. [PMID: 40178914 DOI: 10.1089/respcare.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025]
Affiliation(s)
- Bryan D Kraft
- Drs. Kraft and Kollef are affiliated with Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Elisa Goodman
- Ms. Goodman, Ms. Fordson, Ms. Samih, Mr. Kumawat and Mr. Wade are affiliated with Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Dawn Sitler
- Ms. Sitler and Ms. Gibson are affiliated with Medical Intensive Care Unit, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Tiffany Fordson
- Ms. Goodman, Ms. Fordson, Ms. Samih, Mr. Kumawat and Mr. Wade are affiliated with Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Charlotte Gibson
- Ms. Sitler and Ms. Gibson are affiliated with Medical Intensive Care Unit, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Nizama Samih
- Ms. Goodman, Ms. Fordson, Ms. Samih, Mr. Kumawat and Mr. Wade are affiliated with Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Himanshu Kumawat
- Ms. Goodman, Ms. Fordson, Ms. Samih, Mr. Kumawat and Mr. Wade are affiliated with Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Palmer Wade
- Ms. Goodman, Ms. Fordson, Ms. Samih, Mr. Kumawat and Mr. Wade are affiliated with Respiratory Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Marin H Kollef
- Drs. Kraft and Kollef are affiliated with Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
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Guan X, Tian Y, Yang J, Jiang Y, Luo X, Li Y, Chen C. The application of reinforced endotracheal tubes with pressure indicators in preventing postoperative airway-related complications in neurosurgical patients: a randomized controlled study. BMC Anesthesiol 2025; 25:90. [PMID: 39979812 PMCID: PMC11841299 DOI: 10.1186/s12871-025-02967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 02/12/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Excessive cuff pressure can lead to complications associated with endotracheal intubation. This study aims to compare the effects of cuff inflation guided by a pressure indicator versus the tactile estimation method on postoperative airway-related complications in neurosurgical patients. METHODS This study employed a prospective, randomized, double-blind, controlled design. Blinding was implemented for the subjects and data collectors. Subjects were randomly divided into two groups. The intervention group used tracheal tubes with pressure indicators. The control group used standard reinforced tracheal tubes. The primary outcome measure was the score of tracheal mucosal injury in two groups of subjects under bronchoscopy assistance with extubation. Secondary outcome measures included: (1) the incidence of tracheal mucosal injury assessed by bronchoscopy at the time of extubation; (2) the incidence of blood-stained cuff during extubation; (3) the incidence and severity of sore throat, and the incidence of hoarseness, blood-stained sputum, and coughing at 1 h and 24 h post-extubation. RESULTS The intervention group demonstrated a significantly lower tracheal mucosal injury score before extubation compared to controls (1.4 ± 0.274 vs. 2.7 ± 0.335; P = 0.009). There were no significant differences in immediate post-extubation complications or short-term (1-hour) postoperative symptoms. Notably, while the majority of 24-hour post-extubation outcomes remained comparable between groups, the intervention group exhibited significantly reduced sore throat severity at this timepoint (P = 0.044). CONCLUSION The use of tracheal tubes with pressure indicators to control intraoperative cuff pressure could reduce postoperative airway mucosal damage in neurosurgical patients and alleviated post-extubation pharyngeal pain after 24 h. TRIAL REGISTRATION ChiCTR2200065315, first registered on 02/11/2022. The study was retrospectively registered.
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Affiliation(s)
- Xiaoqin Guan
- Department of Anesthesiology, Dujiangyan Traditional Chinese Medicine Hospital, Chengdu, Sichuan, People's Republic of China
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ying Tian
- Department of Anesthesiology, The Second Affiliated Hospital of Chengdu Medical College & National Nuclear Corporation 416 Hospital, Chengdu, Sichuan, People's Republic of China
| | - Jiaqi Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012)-Chinese Academy, Chengdu, Sichuan, People's Republic of China
| | - Yingying Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012)-Chinese Academy, Chengdu, Sichuan, People's Republic of China
| | - Xiaoqin Luo
- Department of Anesthesiology, Ganzi Tibetan Autonomous Prefecture People's Hospital, Kangding, Sichuan, People's Republic of China
| | - Yu Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012)-Chinese Academy, Chengdu, Sichuan, People's Republic of China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- The Research Units of West China (2018RU012)-Chinese Academy, Chengdu, Sichuan, People's Republic of China.
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Supaopaspan W, Phongdara S, Vijitpavan A. Endotracheal Tube Cuff Inflation Methods in School-Age Children: Flow-Volume Loop-Guided Versus Stethoscope-Guided. Respir Care 2025; 70:176-183. [PMID: 39964846 DOI: 10.1089/respcare.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
Background: In pediatric patients, the intracuff pressure of endotracheal tubes should be as low as possible to prevent injury to the tracheal mucosal wall. The conventional stethoscope-guided technique relies solely on the operator's sensitivity of audible detection, which may lead to increased intracuff pressure. This study was conducted to compare the flow-volume loop guided technique for endotracheal tube cuff inflation with the stethoscope-guided technique and to determine whether the flow-volume loop guided technique results in lower and more consistent intracuff pressure. Methods: The participants were randomized to undergo either the flow-volume loop guided or the stethoscope-guided cuff inflation technique. In the flow-volume loop guided group, the cuff was inflated until the flow-volume loop was completely sealed. In the stethoscope-guided group, the cuff was inflated until the leakage was not audible. Cuff inflation was performed twice with incremental volumes of 0.5 mL and 0.2 mL to determine the consistency of the methods. The primary outcome was the intracuff pressure, and the secondary outcome was the incidence of postextubation complications. Results: Eighty participants (4 to 12 years old) were included in this study. The use of the flow-volume loop guided technique was associated with a lower cuff pressure versus use of the stethoscope-guided technique when inflated at the 0.5-mL increment [14 (6-18) cm H2O vs 19 (9-24) cm H2O; P < .001] and at the 0.2-mL increment [14 (6-18) cm H2O vs 18 (9-24) cm H2O; P < .001], with better consistency between the measured cuff pressures (z = -2.299; P = .02). The presence of postextubation complications (6/80) was not significantly different between the 2 groups but was associated with the American Society of Anesthesiologists physical status (P < .001). Conclusions: The flow-volume loop guided technique for endotracheal tube cuff inflation is a more objective technique that effectively seals the airway with the lower cuff pressure to allow for mechanical ventilation in pediatric subjects during anesthesia.
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Affiliation(s)
- Witchaya Supaopaspan
- Drs Supaopaspan, Phongdara, and Vijitpavan are affiliated with the Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sawapat Phongdara
- Drs Supaopaspan, Phongdara, and Vijitpavan are affiliated with the Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Amorn Vijitpavan
- Drs Supaopaspan, Phongdara, and Vijitpavan are affiliated with the Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Tetiker S, Akdogan HN, Alpay N, Dogan MC. Effect of Dental Throat Pack Used Under General Anesthesia in Children with Special Healthcare Needs on Postoperative Nausea, Vomiting, and Sore Throat: A Randomized Clinical Trial. J Clin Med 2025; 14:567. [PMID: 39860573 PMCID: PMC11766248 DOI: 10.3390/jcm14020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/14/2025] [Accepted: 01/15/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objective: Throat packs are widely used during orofacial surgery to reduce the frequency of postoperative nausea and vomiting (PONV). However, evidence supporting their use is mixed, with associated risks such as postoperative sore throat and the possibility of being forgotten in situ. Methods: The aim of this study is to evaluate the effectiveness of throat packs in preventing PONV and postoperative sore throat during dental treatments under general anesthesia in children with special healthcare needs (SHCNs). Eighty children with SHCNs were randomized into two groups: throat packing (Group TP, n = 41) and no throat packing (Group n-TP, n = 39). A throat pack was used in Group TP, and PONV and sore throat were evaluated at 1, 2, and 4 h postoperatively. Statistical Package for Social Sciences (SPSS) version 23.0 was used for data analysis. The registration number at ClinicalTrials.gov is NCT06169306, registered on 28 December 2023. Results: Patients in Group n-TP showed significantly higher PONV values at 1 and 2 h postoperatively (p < 0.001, p = 0.019, respectively). Visual Analog Scale (VAS) values were also significantly higher in Group TP at 1 and 2 h postoperatively (p < 0.001, p = 0.002, respectively). Conclusions: Using throat packs in dental treatments under general anesthesia for children with SHCNs reduced the incidence of PONV but increased the incidence of postoperative sore throat.
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Affiliation(s)
- Sibel Tetiker
- Department of Anesthesiology and Reanimation, Faculty of Dentistry, Cukurova University, 01250 Adana, Turkey;
| | - Hacer Nida Akdogan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, 01250 Adana, Turkey; (H.N.A.); (M.C.D.)
| | - Nilgun Alpay
- Department of Anesthesiology and Reanimation, Faculty of Dentistry, Cukurova University, 01250 Adana, Turkey;
| | - Muharrem Cem Dogan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, 01250 Adana, Turkey; (H.N.A.); (M.C.D.)
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Nwosu ADG, Ossai EN, Ejezie C, Obodo OC. Educational Intervention Can Improve the Pilot Balloon Palpation Method of Tracheal Tube Cuff Pressure Monitoring: An Experimental Study. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2025; 15:53-58. [PMID: 39735817 PMCID: PMC11676018 DOI: 10.4103/jwas.jwas_162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/01/2024] [Indexed: 12/31/2024]
Abstract
Background Considerable morbidity is attributable to inappropriate tracheal cuff pressure. An earlier study undertaken in our hospital revealed that a normal cuff pressure of 20-30 cm H2O was achieved in only 6% of intubated patients using subjective estimation methods. Objective To determine whether a training intervention could improve the accuracy of the subjective estimation method in our tracheal cuff monitoring. Materials and Methods A 1-day training session was conducted in April 2022 for our anaesthesia providers. The cuffs of different sizes of endotracheal tubes were inflated to 25 cm H2O, and each staff was requested to feel the turgor of the pilot balloon. Subsequently, anaesthesia providers used pilot balloon palpation for the regulation of the tracheal cuff pressure in consecutive patients undergoing general anaesthesia with endotracheal intubation. During each intubation, a manometer was used to crosscheck the inflated cuff pressure objectively. The incidence of post-operative sore throat was also evaluated. The obtained outcomes were compared with pre-intervention data obtained from an earlier study conducted in the health facility from October 2020 to September 2021. Significant differences were considered when P < 0.05. Results The mean tracheal cuff pressure was improved post-intervention (49.2 ± 24.1 cm H2O versus 77.1 ± 31.1 cm H2O; P < 0.001). A significantly higher proportion of tracheal cuffs (20%; 31/156) were inflated within the normal range compared to 6% (9/141) prior to the intervention (P = 0.003). Fewer patients developed post-operative sore throat following the educational intervention (32.8%; 41/125) versus pre-intervention (47.7%; 53/111; P = 0.019). Conclusion The educational intervention improved the safety of tracheal cuff management, which could positively impact airway management, especially in poor resource settings without cuff manometers.
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Affiliation(s)
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Chijioke Ejezie
- Department of Anaesthesia, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Odichimma Callista Obodo
- Department of Anaesthesia, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Wang C, Yan X, Gao C, Liu S, Bao D, Zhang D, Jiang J, Wu A. 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. J Clin Monit Comput 2024; 38:1379-1386. [PMID: 38733506 DOI: 10.1007/s10877-024-01173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
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.
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Affiliation(s)
- Chen Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China.
| | - Xiang Yan
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
| | - Chao Gao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
| | - Simeng Liu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
| | - Di Bao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
| | - Di Zhang
- Department of Clinical Epidemiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No.8, Beijing, China
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Fu CH, Sung CH. Effects of GlideScope, Pentax Airway Scope, and Macintosh Blade on the incidence of postoperative sore throat: a cohort study of 9,881 patients. BMC Anesthesiol 2024; 24:409. [PMID: 39533185 PMCID: PMC11555873 DOI: 10.1186/s12871-024-02798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Postoperative sore throat (POST) is a common complaint after general anesthesia. POST is defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat after general anesthesia. This condition may affect recovery and patient satisfaction and is associated with many factors, including intubation tools. Previous studies have reported conflicting results on POST. This retrospective cohort study, with sample size of 9,881 patients, was conducted to confirm the hypothesis that the use of video laryngoscopy (VL) is associated with a lower incidence of POST compared with direct laryngoscopy (DL). METHODS Data were extracted from a prospectively maintained quality improvement database. A total of 9,881 patients were included in the study. Statistical analysis was conducted for comparisons of demographic characteristics and to determine the effect of intubation tools on the incidence of POST. RESULTS The patients had similar baseline demographic characteristics. Compared with DL, VL was associated with a lower incidence of POST (12.98% vs. 17.49%, P < 0.001). In addition, the use of Pentax Airway Scope (AWS) was associated with a lower incidence of POST compared with the use of GlideScope (GVL, 8.14% vs. 16.25%, P < 0.001). To better adjust for possible confounding factors, mixed-effects generalized linear model analysis revealed that older age (odds ratio [OR]: 0.995, 95% confidence interval [CI]: 0.992-0.999, P = 0.006), AWS compared to DL (OR: 0.416, 95% CI: 0.350-0.494, P < 0.001), and male sex (OR: 0.836, 95% CI: 0.747-0.935, P = 0.002) are associated with reduced incidence of POST. CONCLUSION Compared with DL, VL is associated with a lower incidence of POST. In addition, the use of AWS is associated with a lower incidence of POST compared with the use of GVL. TRIAL REGISTRATION Retrospectively registered, NCT06515808, date of registration: 23/07/2024.
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Affiliation(s)
- Chun-Hsien Fu
- Department of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No.69, Guizi Rd., Taishan Dist., New Taipei City 24352, Taiwan
| | - Chao-Hsien Sung
- Department of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No.69, Guizi Rd., Taishan Dist., New Taipei City 24352, Taiwan.
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Mu G, Chen S, Chen X, Li Q, Lu B, Yu X. Hydrogen regulated pyroptosis through NLRP3-GSDMD pathway to improve airway mucosal oxidative stress injury induced by endotracheal tube cuff compression. Free Radic Biol Med 2024; 224:287-300. [PMID: 39216558 DOI: 10.1016/j.freeradbiomed.2024.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
The cuff of endotracheal tube (ETT) is an indispensable device for establishing an artificial airway, yet cuff-induced compression often causes damage to the airway mucosa. The mechanism of this damage involves mucosal compression ischemia and the oxidative stress injury following reperfusion. Currently, there is a lack of effective strategies to protect the mucosa. Hydrogen, as a natural antioxidant, has demonstrated significant potential in the prevention and treatment of oxidative stress injuries. This study aimed to determine the protective effects of hydrogen on compressed airway mucosa. We found that the damage to the airway mucosa caused by ETT cuff compression was associated with oxidative stress-induced pyroptosis of airway epithelial cells. Inhalation of hydrogen effectively reduced the levels of reactive oxygen species, significantly ameliorating changes in epithelial cell pyroptosis, and this protective effect is linked to the inhibition of the NLRP3-GSDMD pathway. Further cellular studies, involving knockdown and overexpression of NLRP3, clarified that hydrogen exerts its protective effects on the airway mucosa by inhibiting epithelial cell pyroptosis. Additionally, we observed that using hydrogen-rich saline to inflate the ETT cuff in patients under general anesthesia significantly reduced postoperative sore throat. This study confirms that hydrogen effectively enhances tolerance of airway mucosa to oxidative stress injuries, offering a potential preventive and therapeutic strategy for protecting the airway mucosa in patients undergoing endotracheal intubation.
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Affiliation(s)
- Guo Mu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China; Sichuan Clinical Research Center for Clinical Laboratory, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China; Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan, 643000, China
| | - Shuai Chen
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan, 643000, China
| | - Xinyu Chen
- Chuanbei Medical College, Nangchong, Sichuan, 634700, China
| | - Qiang Li
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China
| | - Bin Lu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China.
| | - Xuan Yu
- Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China; Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, Sichuan, 643000, China.
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Kurt Y, Kaşikçi M, Malaska R. Nursing interventions to prevent pressure injury among open heart surgery patients: A systematic review. Nurs Crit Care 2024; 29:1706-1720. [PMID: 38965753 DOI: 10.1111/nicc.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/20/2024] [Accepted: 06/15/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Nurses are vital in identifying and preventive pressure injuries (PIs) in hospitalized patients undergoing open heart surgery. Interventions to prevent PIs are crucial for every critical patient, and it's essential to recognize that preventing PIs involves a complex intervention. AIM To examine the nursing interventions for the prevention of PI in patients with open heart surgery. METHOD A systematic review study. Web of Science, Science Direct, PubMed, Scopus, MEDLINE Ultimate, CINAHL Ultimate, ULAKBIM, Cochrane Library, Google Scholar and university library databases were scanned. The initial search performed in the databases was updated on 4 February 2023, and on 7 April 2024, for potential publications included in that period. Data between February 2013 and April 2024 were scanned. The databases were searched with the keywords 'pressure injury', 'nursing interventions' and 'open heart surgery'. The systematic compilation process was carried out in accordance with the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. RESULTS Seventeen studies were examined using nursing interventions that applied to the selected study population. Care packages included an inflatable head pad, a pressure sensor mattress cover, multi-layer silicone foam, pressure-reducing coatings, endotracheal tube (ETT) repositioning and cuff pressure regulation. Interventions to reduce PI in open heart surgery patients are applied in the preadmission, perioperative and postoperative periods. CONCLUSION It was concluded that care packages, inflatable head pads, pressure sensor bedspreads, multi-layered silicone foam, pressure-reducing covers, ETT repositioning and cuff pressure regulation were effective in all nursing interventions. The strength of the available evidence was rated from strong to weak. RELEVANCE TO CLINICAL PRACTICE These findings reveal an efficient combination of multi-component nursing interventions for preventing PIs in planning patient care in the intensive care. The interventions that are used throughout the patient's entire care process are crucial for the prevention of PIs.
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Affiliation(s)
- Yeter Kurt
- Faculty of Health Sciences, Fundamentals of Nursing Department, Karadeniz Technical University, Trabzon, Turkey
| | - Mağfiret Kaşikçi
- Fundamentals of Nursing Department, Head of the Nursing Faculty, Atatürk University, Erzurum, Turkey
| | - Reezena Malaska
- Gulf Coast Medical Center, Lee Health, Fort Myers, Florida, USA
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Jin X, Ding Y, Weng Q, Sun C, Liu D, Min J. Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury. Esophagus 2024; 21:456-463. [PMID: 39020058 DOI: 10.1007/s10388-024-01061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/25/2024] [Indexed: 07/19/2024]
Abstract
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.
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Affiliation(s)
- Xianwei Jin
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Yuewen Ding
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Qiaoling Weng
- Department of Anesthesiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chumiao Sun
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Dongbo Liu
- Department of Graduate School, Jiangxi Medical College, Nanchang University, Nanchang, China
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Jia Min
- Department of Anesthesiology, Medical Center of Anesthesiology and Pain, the 1st affiliated hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi, China.
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11
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Tok E, Karaca N, Karakoc O, Alper I. Effect of different patient positions on endotracheal tube cuff pressure in patients undergoing urological procedures: a prospective study. Ann Saudi Med 2024; 44:289-295. [PMID: 39368116 PMCID: PMC11454955 DOI: 10.5144/0256-4947.2024.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/31/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. OBJECTIVES Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. DESIGN Prospective and observational study. SETTING A university hospital in Turkey. PATIENTS AND METHODS Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. MAIN OUTCOME MEASURES The effect of different patient positions on the ETT cuff pressure. SAMPLE SİZE 200 patients. RESULTS The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmH2O). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: P=.003; cough: P=.047). CONCLUSION ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety. LIMITATION We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.
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Affiliation(s)
- Eda Tok
- From the Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Nursen Karaca
- From the Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Ozge Karakoc
- From the Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
| | - Isik Alper
- From the Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey
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12
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Henning J, Hindle L. 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. Afr J Emerg Med 2024; 14:156-160. [PMID: 39005757 PMCID: PMC11245905 DOI: 10.1016/j.afjem.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/21/2024] [Accepted: 06/02/2024] [Indexed: 07/16/2024] Open
Abstract
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.
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Affiliation(s)
- Jandre Henning
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
- Frere Hospital, Department of Emergency Medicine, Amalinda Main Road, East London, 5247, South Africa
| | - Lucy Hindle
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
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13
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Urabe K, Asai T, Okuda Y. Usefulness of an automatic cuff pressure controller (SmartCuff) in inhibiting gasleakage around the cuff after tracheal intubation: a randomized controlled study. J Anesth 2024; 38:86-91. [PMID: 37999786 DOI: 10.1007/s00540-023-03283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Gas leakage around the cuff of a tracheal tube may frequently occur after tracheal intubation and inflation of the cuff. We assessed if the SmartCuff (Smiths Medical Japan, Tokyo, Japan), an automatic cuff pressure controller, would effectively prevent gas leakage. METHODS Seventy adult patients were allocated randomly to one of two groups. After induction of general anesthesia and tracheal intubation, in one group (Syringe group), a syringe was used to inflate the cuff, until there was no audible gas leakage, at the airway pressure at 20 cmH2O. In the other group (SmartCuff group), the SmartCuff was used to maintain the cuff pressure to be 20 cmH2O. The mechanical ventilation (tidal volume of 8 ml.kg-1 and 12 breaths per min) was started. The incidence and percentage of gas leakage, and the proportion of adequate seal (defined as gas leakage of < 10%) between the groups were compared. RESULTS The incidence of audible gas leakage was significantly higher in the Syringe group (10 of 35 patients (28%)) than in the SmartCuff group (none of 35 patients (0%)) (P = 0.00046, 95%CI for difference: 15-43%), and the proportion of adequate seal was significantly lower in the Syringe group (19 of 35 patients (54%)) than in the Smart cuff group (33 of 35 patients (94%)) (P = 0.0001, 95% CI for difference: 20-58%). CONCLUSION Gas leakage may frequently occur after tracheal intubation, and the use of the SmartCuff can effectively maintain the sealing effect of the cuff.
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Affiliation(s)
- Kazuhiro Urabe
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Yasuhisa Okuda
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
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14
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Verma A, Singh G, Trivedi V, Ramkiran KS, Babu MJ, Pandya H, Pujara J. Effect of transesophageal echocardiography probe on tracheal perfusion pressure and ventilatory parameters in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass: A prospective observational study. Ann Card Anaesth 2023; 26:393-398. [PMID: 37861572 PMCID: PMC10691560 DOI: 10.4103/aca.aca_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Overinflation of cuffed endotracheal tubes and transesophageal echocardiography (TEE) probe causes increased intracuff pressure (CP) compromising tracheal perfusion pressure (TPP). Primary objective of the study was to assess CP, TPP on TEE probe insertion and examination during pediatric cardiac surgeries. Secondary objectives were to evaluate the effect of the probe on peak airway pressures (Ppeak), mean airway pressures (Pmean) and to monitor CP, TPP on cardiopulmonary bypass (CPB). Materials and Methods This prospective observational study included fifty patients, aged 1-5 years undergoing cardiac surgeries using CPB. Following induction, TEE probe was introduced. CP, TPP, Ppeak, Pmean were measured before insertion of TEE probe (T1), during probe insertion (T2) and examination at mid-esophageal (T3), transgastric level (T4), and on removing probe (T6). CP, TPP were monitored on CPB (T5). Statistical analysis was done using paired t-test. Results CP, Ppeak and Pmean increased significantly, while TPP decreased significantly from T1 to T2, T3, T4 (P < 0.001). CP, TPP decreased significantly at T5 in comparison to T6 (P < 0.001). In 48% of the patients CP increased above 30 cm H2O at T2. Conclusion TEE probe causes an increase in CP and decreases TPP. Constant monitoring and maintaining CP, TPP in optimum range is recommended.
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Affiliation(s)
- Abhishek Verma
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Guriqbal Singh
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Visharad Trivedi
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - KS Ramkiran
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Mittapalli Jeevan Babu
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Himani Pandya
- Department of Research, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Jigisha Pujara
- Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Sejkorová A, Bolcha M, Beneš J, Kalhous J, Sameš M, Vachata P. Intraoperative Measurement of Endotracheal Tube Cuff Pressure and Its Change During Surgery in Correlation With Recurrent Laryngeal Nerve Palsies, Hoarseness, and Dysphagia After Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial. Global Spine J 2023; 13:1635-1640. [PMID: 34586006 PMCID: PMC10448091 DOI: 10.1177/21925682211046895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Prospective randomized controlled trial. OBJECTIVES Adjustment of endotracheal tube cuff pressure (ETCP) in anterior cervical discectomy and fusion (ACDF) may influence the incidence of complications such as recurrent laryngeal nerve palsy (RLNP), hoarseness, and dysphagia. METHODS The prospective randomized controlled trial was designed to investigate the influence of ETCP on the incidence of postoperative complications. All eligible patients underwent vocal cord examination before and after ACDF and were randomized into a control group (CG) and intervention group (IG). Endotracheal tube cuff pressure was passively monitored in CG, and in IG, it was maintained at 20 mmHg. Outcomes were evaluated during hospitalization and during follow-up. RESULTS A total of 98 patients were randomized, each group consisted of 49 patients. Statistical analysis showed that gender and age did not influence the incidence of complications. In CG, duration of retractor placement and extent of approach significantly impacted the occurrence of complications. The incidence of postoperative RLNP was 8.2% in IG and 12.2% in CG, hoarseness and dysphonia were present in 18.4% in IG and in 37.5% in CG, and dysphagia in 20.8% in IG and in 22.5% in CG. Hoarseness was significantly present more in CG (P = .018). Only one patient from CG presented with RLNP after 1 year, the remaining nine patients spontaneously recovered. CONCLUSIONS Unregulated ETCP can lead to a significantly higher incidence of hoarseness; however, its improvement rate is 100%. The early postoperative complication rate was higher in CG, and after one year, 1 patient had RLNP and 1 patient had dysphagia.
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Affiliation(s)
- Alena Sejkorová
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- Second Faculty of Medicine in Prague, Charles University in Prague, Prague, Czech Republic
| | - Martin Bolcha
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- The Faculty of Medicine in Pilsen, Department of Neurosurgery, University Hospital in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Jan Beneš
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Masaryk Hospital, J J. E. Purkyně University, Ústí nad Labem, Czech Republic
- Faculty of Medicine in Hradec Kralove, University Hospital, Charles University in Prague, Hradec Kralove, Czeck Republic
| | - Jiří Kalhous
- Faculty of Medicine in Hradec Kralove, University Hospital, Charles University in Prague, Hradec Kralove, Czeck Republic
- Department of Otorhinolaryngology, Head and Neck Surgery Department, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
| | - Petr Vachata
- Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic
- The Faculty of Medicine in Pilsen, Department of Neurosurgery, University Hospital in Pilsen, Charles University in Prague, Prague, Czech Republic
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16
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Park S, Kwon YI, Kim HJ. Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study. Front Med (Lausanne) 2023; 10:1161566. [PMID: 37342495 PMCID: PMC10277466 DOI: 10.3389/fmed.2023.1161566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Objective Inflation of the endotracheal tube cuff is needed for providing ventilation. Cuff pressure should be maintained inside the appropriate range to prevent critical airway complications. The purpose of this study is to evaluate the pressure changes in the endotracheal tube cuff during otorhinolaryngologic surgery. Design and method This single-center observational study was conducted at Severance Hospital in Korea between April 2020 and November 2020. Patients aged >20 years scheduled to undergo otorhinolaryngological surgical procedures were enrolled. Patients undergoing planned tracheostomy and those who were slated for uncuffed endotracheal tube use were excluded. Intubation was performed after the induction of general anesthesia. A pressure transducer was connected to the pilot balloon of the endotracheal tube, and cuff pressure was continuously monitored until extubation. If the cuff pressure was not appropriate for more than 5 min, it was adjusted to the appropriate range by injecting or removing air. The percentage of time for which the cuff pressure remained within the appropriate range was calculated and defined as the time in the therapeutic range (TTR). The presumed cause for the rise or fall in cuff pressure was identified. Results In total 199 patients, alterations in cuff pressure outside the appropriate range occurred in 191 patients (96.0%). The mean TTR was 79.7% (SD 25.0%), and head and neck surgery had the lowest mean TTR of 69.0% compared to ear and nose surgeries (94.2 and 82.1%, respectively). Sixty-eight patients (34.2%) demonstrated inadequate endotracheal tube cuff pressure for more than 20% of the total anesthesia time. Twenty-six patients (13.1%) demonstrated optimal endotracheal tube cuff pressure for less than 50% of the total anesthesia time. The causative factors inducing inappropriate cuff pressure were found to vary, including positional changes, surgical procedure, anatomical manipulation, and anesthetic procedure. Conclusion In otorhinolaryngologic surgery, cuff pressure increased or decreased outside the appropriate range due to various factors. Therefore, we suggest close continuous monitoring of cuff pressure during anesthesia for otorhinolaryngologic surgery. Clinical trial registration clinicaltrials.gov, identifier NCT03938493.
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Wang C, Yan X, Gao C, Liu S, Zhang D, Jiang J, Wu A. Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: study protocol for a randomized controlled trial. Trials 2023; 24:358. [PMID: 37237312 DOI: 10.1186/s13063-023-07406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Postoperative sore throat (POST) is a common postoperative complication after endotracheal tube removal. There are still no effective preventive methods for POST. The aim of this trial is to confirm whether maintaining intraoperative cuff pressure below the tracheal capillary perfusion pressure could effectively reduce the incidence of POST among patients undergoing gynecological laparoscopic surgery. METHODS This study is a single-center, randomized, parallel-controlled, superiority trial with a 1:1 allocation ratio. Sixty patients whose age is between 18 and 65 years and scheduled for gynecological laparoscopic surgery will be randomized to the cuff pressure measurement and adjustment (CPMA) group and the only cuff pressure measurement without adjustment group (control group). The primary endpoint is the incidence of sore throat at rest within 24 h after extubation. The secondary endpoints include the incidence of cough, the incidence of hoarseness, the incidence of postoperative nausea and vomiting (PONV), POST, and pain intensity within 24 h after extubation. Blocked randomization will be conducted with a computer-generated central randomization online service. The blind method will be applied to subjects, data collectors, outcome evaluators, and statisticians. Outcome assessments will be performed at 0 h and 24 h post-extubation. DISCUSSION This randomized controlled study hypothesizes that cuff pressure is the primary influencing factor of POST. By continuous monitoring of endotracheal tube cuff pressure and maintaining it within the range of 18-22 mmHg compared with only continuous measurement without adjustment, it aims to prove that continuous measurement and adjustment of endotracheal tube cuff pressure could be effective in reducing the incidence of POST in gynecological laparoscopic surgery patients. The result of this study could be used as a reference for future multicenter studies to confirm the effect of cuff pressure on POST and provides a scientific theoretical basis for preventing POST to further support comfort medicine. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200064792. Registered on 18 October 2022. This protocol (version 1.0, 16 March 2022) was approved by the Ethics Committee of Beijing Chaoyang Hospital.
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Affiliation(s)
- Chen Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China
| | - Xiang Yan
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China
| | - Chao Gao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China
| | - Simeng Liu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China
| | - Di Zhang
- Department of Clinical Epidemiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Gongrentiyuchang South Road No. 8, Beijing, China.
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Mangiameli G, Perroni G, Costantino A, De Virgilio A, Malvezzi L, Mercante G, Giudici VM, Ferraroli GM, Voulaz E, Giannitto C, Acocella F, Onorati I, Martinod E, Cariboni U. Analysis of Risk Factors for Tracheal Stenosis Managed during COVID-19 Pandemic: A Retrospective, Case-Control Study from Two European Referral Centre. J Pers Med 2023; 13:jpm13050729. [PMID: 37240899 DOI: 10.3390/jpm13050729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Benign subglottic/tracheal stenosis (SG/TS) is a life-threatening condition commonly caused by prolonged endotracheal intubation or tracheostomy. Invasive mechanical ventilation was frequently used to manage severe COVID-19, resulting in an increased number of patients with various degrees of residual stenosis following respiratory weaning. The aim of this study was to compare demographics, radiological characteristics, and surgical outcomes between COVID-19 and non-COVID patients treated for tracheal stenosis and investigate the potential differences between the groups. MATERIALS AND METHODS We retrospectively retrieved electronical medical records of patients managed at two referral centers for airways diseases (IRCCS Humanitas Research Hospital and Avicenne Hospital) with tracheal stenosis between March 2020 and May 2022 and grouped according to SAR-CoV-2 infection status. All patients underwent a radiological and endoscopic evaluation followed by multidisciplinary team consultation. Follow-up was performed through quarterly outpatient consultation. Clinical findings and outcomes were analyzed by using SPPS software. A significance level of 5% (p < 0.05) was adopted for comparisons. RESULTS A total of 59 patients with a mean age of 56.4 (±13.4) years were surgically managed. Tracheal stenosis was COVID related in 36 (61%) patients. Obesity was frequent in the COVID-19 group (29.7 ± 5.4 vs. 26.9 ± 3, p = 0.043) while no difference was found regarding age, sex, number, and types of comorbidities between the two groups. In the COVID-19 group, orotracheal intubation lasted longer (17.7 ± 14.5 vs. 9.7 ± 5.8 days, p = 0.001), tracheotomy (80%, p = 0.003) as well as re-tracheotomy (6% of cases, p = 0.025) were more frequent and tracheotomy maintenance was longer (21.5 ± 11.9 days, p = 0.006) when compared to the non-COVID group. COVID-19 stenosis was located more distal from vocal folds (3.0 ± 1.86 vs. 1.8 ± 2.03 cm) yet without evidence of a difference (p = 0.07). The number of tracheal rings involved was lower in the non-COVID group (1.7 ± 1 vs. 2.6 ± 0.8 p = 0.001) and stenosis were more frequently managed by rigid bronchoscopy (74% vs. 47%, p = 0.04) when compared to the COVID-19 group. Finally, no difference in recurrence rate was detected between the groups (35% vs. 15%, p = 0.18). CONCLUSIONS Obesity, a longer time of intubation, tracheostomy, re-tracheostomy, and longer decannulation time occurred more frequently in COVID-related tracheal stenosis. These events may explain the higher number of tracheal rings involved, although we cannot exclude the direct role of SARS-CoV-2 infection in the genesis of tracheal stenosis. Further studies with in vitro/in vivo models will be helpful to better understand the role of inflammatory status caused by SARS-CoV-2 in upper airways.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Luca Malvezzi
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Giorgio Maria Ferraroli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Fabio Acocella
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Ilaria Onorati
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
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Oh H, Sohn JY, Ma S, Choi S, Kim YJ, Lee HC, Lee CH, Kim CH, Chung CK, Park HP. High peak inspiratory pressure may be associated with intraoperative coughing during neurosurgery under general anesthesia without neuromuscular blockade: a retrospective study. BMC Anesthesiol 2023; 23:123. [PMID: 37059969 PMCID: PMC10103441 DOI: 10.1186/s12871-023-02080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The endotracheal cuff pressure depends on the airway pressure during positive-pressure ventilation. A high endotracheal cuff pressure may be related to intraoperative coughing, which can be detrimental during neurosurgery. We investigated the incidence of intraoperative coughing and its association with peak inspiratory pressure (PIP) during neurosurgery under general anesthesia without neuromuscular blockade. METHODS This retrospective study divided 1656 neurosurgical patients who underwent total intravenous anesthesia without additional neuromuscular blockade after tracheal intubation into high (PIP > 21.6 cmH2O, n = 318) and low (PIP ≤ 21.6 cmH2O, n = 1338) PIP groups. After propensity score matching, 206 patients were selected in each group. Demographic, preoperative, surgical, and anesthetic data were collected retrospectively from electronic medical records and continuous ventilator, infusion pump, and bispectral index data from a data registry. RESULTS Intraoperative coughing occurred in 30 (1.8%) patients, including 9 (0.5%) during the main surgical procedure. Intraoperative coughing was more frequent in the high PIP group than in the low PIP group before (14/318 [4.4%] vs. 16/1338 [1.2%], P < 0.001) and after (13/206 [6.3%] vs. 1/206 [0.5%], P = 0.003) propensity score matching. In multivariable logistic regression analysis after propensity score matching, a high PIP (odds ratio [95% confidence interval] 14.22 [1.81-111.73], P = 0.012), tidal volume divided by predicted body weight (mL/kg, 1.36 [1.09-1.69], P = 0.006), and surgical duration (min, 1.01 [1.00-1.01], P = 0.025) predicted intraoperative coughing. CONCLUSION The incidence of intraoperative coughing was 1.8% in neurosurgical patients undergoing general anesthesia without neuromuscular blockade and might be associated with a high PIP.
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Affiliation(s)
- Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seoyoung Ma
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Ban MG, Kim SY, Kim MS, Park WK, Kwon YI, Kim HJ. Accuracy of pilot balloon palpation for cuff pressure assessment in small versus large sized tubes: a prospective non-randomized observational study. Sci Rep 2023; 13:5580. [PMID: 37020098 PMCID: PMC10076498 DOI: 10.1038/s41598-023-32704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Pilot balloon palpation is still a commonly used method to evaluate cuff pressure of the endotracheal tube after intubation. This study determined whether the size of the tracheal tube influenced the accuracy of pilot balloon palpation. A prospective observational analysis of 208 patients intubated with an endotracheal tube of internal diameter (ID) 6.0 or 8.0 was conducted. An anesthesiologist judged the cuff pressure by manual pilot balloon palpation, and then measured the cuff pressure with a pressure gauge. Cuff pressure exceeding 20-30 cmH2O was defined as false recognition. The intracuff pressure was significantly higher in ID 6.0 tube than in the ID 8.0 tube (41.9 ± 18.8 cmH2O vs. 30.3 ± 11.9 cmH2O, p < 0.001). The number of patients that were mistakenly perceived to have appropriate cuff pressure by pilot balloon palpation was significantly higher in the ID 6.0 group compared to the ID 8.0 group (85 (81.7%) vs. 64 (61.5%), p = 0.001). Therefore, a smaller tube size may further increase risk of inaccurate measurement by pilot balloon palpation and although pressure gauge is recommended for all sizes to maximize accuracy, groups with increased risk factors should be targeted for standardized use of the pressure gauge.
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Affiliation(s)
- Min Gi Ban
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young In Kwon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Er ÖS, Van Giersbergen MY, Çelik S. Effects of three endotracheal tube cuff pressure control measures on microaspiration of gastric content: Study protocol for randomised controlled trial. J Clin Nurs 2023; 32:1476-1486. [PMID: 36002981 DOI: 10.1111/jocn.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
AIM To analyse the effect of endotracheal tube cuff pressure control measures on the microaspiration of the stomach contents by measuring at the level of pepsin in deep tracheal aspiration. DESIGN A single-blind, randomised controlled trial. METHODS This trial protocol was reported using the SPIRIT checklist. Endotracheal tube cuff pressure control will be provided with pilot balloon finger palpation, intermittent and continuous. The pepsin level will be measured during deep tracheal secretions in order to assess the effect of different endotracheal tube cuff pressure control measures on the microaspiration of the stomach contents. The samples will be examined within the first 4 h, between the 5th and 24th hours, and between the 25th and 48th hours after intubation. The level of pepsin will be considered positive according to the cut-off value. In addition, the effect of different endotracheal tube cuff pressure controls on the incidence of ventilator-associated pneumonia will be examined. In study group 1, study group 2 and the control group, the number of patients is planned to be 56. TRIAL REGISTRATION ClinicalTrials.gov Identifier, Number NCT04061083. Registered in 2019. DISCUSSION The findings will show the effect of different endotracheal tube cuff pressure control methods on microaspiration of stomach content and the possible changes in pepsin level in deep tracheal aspirates. CONCLUSION This study will shed light on future studies regarding pepsin level as a biomarker in treatment and follow-up patients receiving mechanical ventilator support using an ETT and emphasise the importance of multidisciplinary studies. RELEVANCE TO CLINICAL PRACTICE As a result of the findings to be obtained from this study, the effect of endotracheal tube cuff pressure control on gastric content microaspiration and ventilator-associated pneumonia will be determined and the most appropriate endotracheal tube cuff pressure control method will be identified to prevent it. Nurses' awareness of endotracheal tube cuff pressure measurement methods will be increased. The frequency and methods of endotracheal tube cuff pressure control will provide strong evidence that can be included in the ventilator-associated pneumonia prevention care bundle.
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Affiliation(s)
- Özlem Soyer Er
- Nursing Department, Faculty of Health Science, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | | | - Sefa Çelik
- Department of Biochemistry, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Preoperative gum chewing for different durations to prevent postoperative sore throat after endotracheal intubation: A randomized controlled trial. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Complications secondary to endotracheal intubation in dogs and cats – A questionnaire-based survey among veterinary anaesthesiologists. Vet Anaesth Analg 2023; 50:220-229. [PMID: 37069018 DOI: 10.1016/j.vaa.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To investigate anaesthesiologists' attitudes towards endotracheal intubation and the perceived incidence of complications secondary to endotracheal intubation in dogs and cats. STUDY DESIGN A cross-sectional online questionnaire-based study. METHODS Using an online questionnaire distributed via electronic mail, the perceived incidence of complications secondary to endotracheal intubation in dogs and cats was investigated. Attitudes towards endotracheal intubation, average caseload and percentage of animals intubated were examined. The study population consisted of Diplomates, Residents, and residency trained members of the American and European Colleges of Veterinary An(a)esthesia and Analgesia. Univariate descriptive statistics were calculated. For each complication, a mean incidence score (MIS) was calculated, ranging from 1 (never) to 5 (always). Additionally, a Wilcoxon signed-rank test and binary regression analyses were performed. A p value ≤ 0.05 was considered significant. RESULTS The overall response rate was 35.1%, with a completion rate of 26.6%. Most dogs and cats undergoing general anaesthesia were intubated. Endotracheal intubation was viewed as an integral part of modern anaesthesia. Significant differences were found in the incidence of 16 of the 24 examined complications between dogs and cats (p ≤ 0.001). The most frequently perceived complications were reported to be cuff leak (MIS 3.20) and coughing during intubation (MIS 3.10) in dogs, and coughing (MIS 3.01) and laryngeal spasm during intubation (MIS 2.91) in cats. Sociodemographic and practice-specific aspects did not appear to play a significant role in the reported incidence of complications. CONCLUSIONS AND CLINICAL RELEVANCE Endotracheal intubation was considered a state-of-the-art technique by the respondents. It was associated with a perceived low incidence of major complications and more frequent minor ones. Differences between dogs and cats need to be accounted for. Considering the retrospective and self-reporting nature of this survey, true incidences might differ.
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Methods Used for Endotracheal Tube Cuff Inflation and Pressure Verification in Veterinary Medicine: A Questionnaire on Current Practice. Animals (Basel) 2022; 12:ani12223076. [PMID: 36428304 PMCID: PMC9686819 DOI: 10.3390/ani12223076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Endotracheal intubation is a routine procedure in veterinary anaesthesia, yet no consensus guidelines exist for endotracheal tube (ETT) cuff inflation and pressure measurement. The aim of this study was to assess current practice of ETT cuff inflation and seal verification in veterinary medicine. An online questionnaire was distributed among veterinary professionals who administer anaesthesia, comprising six demographic and twelve ETT cuff-related questions per species. N = 348 questionnaires were completed. Cuff pressure was measured by 30% of respondents in cats, 32% in dogs and 9% in both farm animals and horses. Anaesthesia diplomates were not more likely to measure cuff pressure than others, except in cats (OR: 1.8; 95% CI: 1.1−2.9). The most frequently selected recommended range of cuff pressure was 20−30 cm H2O, regardless of species, although >30 cm H2O was selected significantly more often in horses compared to dogs, cats and farm animals. The preferred technique to verify cuff seal was minimal occlusive volume in dogs, cats and farm animals, whereas in horses, the preferred method was verification of normal capnogram waveform. ETT cuff pressure measurement remains uncommon in veterinary anaesthesia. The development of consensus recommendations for cuff inflation, including evidence-based target cuff pressure ranges for various species and different ETT models or materials, can help to improve practice.
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25
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Seol G, Jin J, Oh J, Byun SH, Jeon Y. Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial. World J Clin Cases 2022; 10:11419-11426. [PMID: 36387810 PMCID: PMC9649561 DOI: 10.12998/wjcc.v10.i31.11419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change.
AIM To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation.
METHODS In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH2O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH2O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured.
RESULTS The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH2O) than in the cylindrical cuff (25.5 ± 0.8 cmH2O) after head and neck extension (P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) (P < 0.001). The incidence of postoperative airway complications was comparable between two groups.
CONCLUSION After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.
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Affiliation(s)
- Gukjin Seol
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu 41944, South Korea
| | - Juhwa Jin
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Sung-Hye Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu 41944, South Korea
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26
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Satya Prakash M, Aravind C, Mohan V. Comparative evaluation of three methods of endotracheal tube cuff inflation for adequacy of seal. J Anaesthesiol Clin Pharmacol 2022; 38:588-593. [PMID: 36778817 PMCID: PMC9912873 DOI: 10.4103/joacp.joacp_560_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Aims Intubation with cuffed endotracheal tube (ETT) is common in operation rooms, critical care, and emergency rooms. The pressure exerted by the cuff on the tracheal mucosa can lead to a reduction in blood flow to the tracheal wall and result in mucosal ischemia. There are many methods for ETT cuff inflation. Aim of the study was to compare the cuff pressures and volumes between the three methods of ETT cuff inflation. Material and Methods One hundred and twenty patients were randomized into three groups: Group SG (stethescope guided), group AL (audible leak), and group P (palpation). In group SG, the cuff was inflated by auscultating with the bell of the stethoscope over the thyroid cartilage for leak around cuff. In group AL, the cuff was inflated by listening for an audible leak around the cuff with observer's ear 5 cm away from the mouth of the patient. In group P, the cuff was inflated by palpating for a leak over the cricoid and trachea. The adequacy of the cuff seal was compared between the groups by assessing the volumes of additional air needed to stop the leak around the cuff as confirmed by supraglottic capnometry. Results The initial volumes needed to inflate the cuff were significantly more in the stethoscope (SG) and hearing (AL) groups than in the palpation (P) group (SG = 5.1 ± 1.4 ml, AL = 4.6 ± 1.6 ml, P = 3.1 ± 0.9 ml; SG and AL vs. P, P < 0.001). Additional cuff volumes required to achieve zero leak around cuff by supraglottic capnometry were 0.85 ± 1 ml in group SG, 1.3 ± 1.1 ml in group AL, and 2.237 ± 0.8 ml in group P (SG vs. P and AL vs. P; P < 0.001). Conclusion Out of the auscultation-guided, audible leak-guided, and palpation-guided methods of ETT cuff inflation, the auscultation-guided and audible leak-guided methods achieve significantly better tracheal seal than the palpation-guided method.
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Affiliation(s)
| | - C Aravind
- Department of Anaesthesiology and CC, JIPMER, Puducherry, India
| | - V.K. Mohan
- Department of Anaesthesiology and CC, JIPMER, Puducherry, India
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Maddali MM, Al Hadifi TSM, Sathiya PM, Jose S. The Effect of Intraoperative Transesophageal Echocardiography Probe Placement on the Endotracheal Tube Cuff Pressure in Adult Patients Undergoing On-Pump Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:3084-3089. [PMID: 35365372 DOI: 10.1053/j.jvca.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The study was directed toward documentation of the effect of transesophageal echocardiography (TEE) probe insertion on the endotracheal tube cuff pressure (CP) in adult patients undergoing on-pump coronary bypass surgery. The primary objective of this study was to assess whether CP reaches supranormal pressures during the different stages of intraoperative TEE examination. The secondary objective was to observe the effect of TEE probe placement on the ventilation parameters. DESIGN A prospective observational study. SETTING At a tertiary care cardiac center. PARTICIPANTS Thirty-four cardiac surgical patients older than 18 years of age who required intraoperative TEE examination. INTERVENTIONS TEE probe insertion. MEASUREMENTS AND MAIN RESULTS Following the induction of general anesthesia and tracheal intubation, a TEE probe was introduced. The endotracheal tube CP was recorded at 5 time zones: Before TEE probe insertion, during the insertion of the probe, during probe manipulation, probe in the transgastric position, and during removal of the probe. A nonparametric test was used for comparing intracuff pressure between pairs of time zones. There was a statistically significant difference in CP values between the baseline and those during different time zones (chi-square test = 134.77, degrees of freedom = 4, p = 0.001). There was a statistically significant difference in the peak pressure between different time points compared to baseline (p = 0.0001). CONCLUSIONS TEE probe placement in patients with tracheal intubation may be associated with a significant increase in CP well above the baseline pressure. With the possibility of the mean arterial pressures during cardiopulmonary bypass being substantially lower than expected, the findings of the current study raised the concern of predisposing the tracheal mucosa to hypoperfusion, with subsequent temporary or permanent tracheal damage. Hence, at least a baseline estimation of the endotracheal tube CP at the time of tracheal intubation, with the help of a pressure gauge in the operating room, may be considered as a safe practice.
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Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | | | | | - Sachin Jose
- Department of Studies and Research, Oman Medical Specialty Board, Muscat, Oman
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Gupta P, Sharma S, Vishnoi A, Kanoji S, Moin K. The Comparison of Inflation of Cuff with 1% Propofol, 4% Lignocaine, or 0.9% Saline on Laryngotracheal Morbidity. Anesth Essays Res 2022; 16:311-315. [PMID: 36620105 PMCID: PMC9814000 DOI: 10.4103/aer.aer_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Aim While administering general anesthesia requiring endotracheal intubation, it is a common practice to inflate the cuff with air. Continuous pressure exerted by cuff on mucosa may lead to postoperative complaints such as sore throat, cough, and dysphagia, which are very disturbing to the patient. Hence, we hypothesized that inflation of cuff with propofol may reduce the incidence of these complications as a result of cushioning effect as well as non-diffusion of nitrous oxide into it. Our aim was to compare the effects of inflation of endotracheal tube cuff with 0.9% saline, 4% lignocaine, and 1% propofol on the incidence of postoperative morbidity in terms of cough, sore throat, dysphonia, and dysphagia with general anesthesia using nitrous oxide. Methods Patients scheduled for elective surgery under general anesthesia were randomly allocated into four equal groups of thirty each as per cuff inflation media: air (Group A), 0.9% saline (Group S), 4% lidocaine (Group L), and 1% propofol (Group P). The incidence of cough was noted at 15, 30 and 60 min after extubating. The occurrence and severity of postoperative sore throat (POST) was evaluated at 2, 6, and 24 h after extubating. Results The incidence of cough was maximum in Group A and minimum in Group P (P < 0.05). The occurrence of POST was highest in Group A, followed by Group S and Group L, and least in Group P. The hemodynamic parameters were comparable with no statistical difference in all the four groups (P < 0.05). Conclusion The intracuff 1% propofol is superior to 4% xylocaine and normal saline in the prevention of cough and sore throat postoperatively, whereas inflation of cuff with air leads to maximum incidence of these complications.
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Affiliation(s)
- Priyamvada Gupta
- Department of Critical Care, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sunita Sharma
- Department of Neuroanesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Anshul Vishnoi
- Department of General Anesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sakshi Kanoji
- Department of General Anesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Khayyam Moin
- Department of General Anesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Irisawa T, Nagamine Y, Gamo M, Tanaka H, Goto T. The Elevation of Double Lumen Tube Cuff Pressure during Lung Surgery: A Single Center Prospective Observational Study. J Cardiothorac Vasc Anesth 2022; 36:3824-3832. [DOI: 10.1053/j.jvca.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 11/11/2022]
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Wang TT, Wang J, Sun TT, Hou YT, Lu Y, Chen SG. Perianesthesia emergency repair of a cut endotracheal tube’s inflatable tube: A case report. World J Clin Cases 2022; 10:4594-4600. [PMID: 35663091 PMCID: PMC9125295 DOI: 10.12998/wjcc.v10.i14.4594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During the perianesthesia period, emergency situations threatening the life and safety of patients can occur at any time. When dealing with some emergencies, occasional confusion is inevitable.
CASE SUMMARY This case report describes the rare situation wherein a surgeon inadvertently detached the inflatable tube of an endotracheal tube during a tonsillectomy, and positive pressure ventilation could not be provided. While reintubation may increase the risk of respiratory tract infection and aspiration, patients with a difficult airway might die due to apnea. The best treatment method is to optimize the damaged tracheal tube junction to avoid secondary intubation and ensure patient safety. An intravenous needle and cannula were used to repair the damaged gap in the current case. Following the repair, the anesthesia machine showed no indication of low tidal volume, and there was no deflation of the endotracheal tube cuff. Subsequently, the patient was transferred to the post-anesthesia recovery room, and the tracheal tube was removed with satisfactory results.
CONCLUSION Using an intravenous needle to repair a break in the inflatable tube surrounding an endotracheal tube is safe and reliable.
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Affiliation(s)
- Ting-Ting Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Jiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Ting-Ting Sun
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Yu-Ting Hou
- Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Shan-Gui Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
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Piazza C, Lancini D, Filauro M, Sampieri C, Bosio P, Zigliani G, Ioppi A, Vallin A, Deganello A, Peretti G. Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:99-105. [PMID: 35612502 PMCID: PMC9132000 DOI: 10.14639/0392-100x-n1952] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
Objective The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation. Methods A case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021. Results Among 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors’ classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic. Conclusions With the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.
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COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic? J Clin Med 2022; 11:jcm11061719. [PMID: 35330044 PMCID: PMC8948992 DOI: 10.3390/jcm11061719] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 01/07/2023] Open
Abstract
During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted.
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Affiliation(s)
- J-Y Niu
- Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - N Yang
- Third Affiliated Hospital of Anhui Medical University, Hefei, China
| | - J-M Yu
- Third Affiliated Hospital of Anhui Medical University, Hefei, China
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Nwosu ADG, Ossai EN, Onyekwulu FA, Amucheazi AO, Ewah R, Onwuasoigwe O, Akhideno I. Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country. Patient Saf Surg 2022; 16:4. [PMID: 35027059 PMCID: PMC8759163 DOI: 10.1186/s13037-021-00311-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria. METHODS This was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 tertiary hospitals in Nigeria, selected by stratified random sampling. RESULTS Only 3.1% (6/196) of the care providers admitted having ever used a tracheal cuff manometer, while 31.1% knew the recommended tracheal cuff pressure. The nationwide telephone survey of anaesthesia faculty fellows revealed that tracheal cuff manometer is neither available, nor has it ever been used in any of the 13 tertiary hospitals surveyed. The 'Pilot balloon palpation method' and 'fixed volume of air from a syringe' were the most commonly utilized method of cuff pressure estimation by the care providers, at 64.3% and 28.1% respectively in part A survey (84.6% and 15.4% respectively, in the part B survey). CONCLUSION The use of tracheal cuff manometer is very limited among the care providers surveyed in this study. Knowledge regarding tracheal cuff management among the providers is adjudged to be fair, despite the poor practice and unsafe care.
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Affiliation(s)
| | - Edmund Ndudi Ossai
- Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | | | | | - Richard Ewah
- Department of Anaesthesia, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Okechukwu Onwuasoigwe
- Department of Orthopaedic Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Irene Akhideno
- Department of Anaesthesia, Irrua Specialist Teaching Hospital, Irrua., Edo state, Nigeria
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Owusu-Bediako K, Turner H, Syed O, Tobias J. Options for Intraoperative Repair of a Cut Pilot Balloon on the Endotracheal Tube. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:265-269. [PMID: 34512044 PMCID: PMC8423496 DOI: 10.2147/mder.s323982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
Severing of the pilot balloon of an endotracheal tube (ETT) results in cuff deflation and may lead to complications including inadequate patient ventilation, increased risk of aspiration and infection, and operating room air pollution with anesthetic gases. In situations where ETT exchange or reintubation may pose a significant risk to the patient, temporary repair of the severed cuff tubing can be helpful until it is safe to address the problem with replacing the ETT. Simple and effective repair methods can be achieved using readily available materials in the operating room, including intravenous cannulas, hypodermic syringes, and epidural clamp connectors. However, choosing which technique or method depends mainly on personal preference, equipment availability, and provider comfort and experience. We present a 12-year-old adolescent who presented for anesthetic care for extensive burn injury. During removal of the dressing around the head and face, the tubing of the pilot balloon of the ETT was inadvertently cut. Options for dealing with such problems are discussed, including techniques to allow for temporary repair and re-inflation of the deflated cuff.
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Affiliation(s)
- Kwaku Owusu-Bediako
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry Turner
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Omar Syed
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study. J Clin Med 2021; 10:jcm10173910. [PMID: 34501354 PMCID: PMC8432023 DOI: 10.3390/jcm10173910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
To prevent endotracheal tube-related barotrauma or leakage, the intracuff pressure should be adjusted to 20-30 cm H2O. However, changes in the nasotracheal tube intracuff pressure relative to neck posture are unclear. In this study, we investigated the effect of head and neck positioning on nasotracheal tube intracuff pressure. Fifty adult patients with nasotracheal tubes who were scheduled for surgery under general anesthesia were enrolled. Following intubation, intracuff pressure was measured by connecting the pilot balloon to a device that continuously monitors the intracuff pressure. Subsequently, the intracuff pressure was set to 24.48 cm H2O (=18 mmHg) for the neutral position. We recorded the intracuff pressures based on the patients' position during head flexion, extension, and rotation. The initial intracuff pressure was 42.2 cm H2O [29.6-73.1] in the neutral position. After pressure adjustment in the neutral position, the intracuff pressure was significantly different from the neutral to flexed (p < 0.001), extended (p = 0.003), or rotated (p < 0.001) positions. Although the median change in intracuff pressure was <3 cm H2O when each patient's position was changed, overinflation to >30 cm H2O occurred in 12% of patients. Therefore, it is necessary to adjust the intracuff pressure after tracheal intubation and each positional change.
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Kheirabadi D, Ardekani MS, Honarmand A, Safavi MR, Salmasi E. Comparison Prophylactic Effects of Gargling Different Doses of Ketamine on Attenuating Postoperative Sore Throat: A Single-Blind Randomized Controlled Trial. Int J Prev Med 2021; 12:62. [PMID: 34447504 PMCID: PMC8356970 DOI: 10.4103/ijpvm.ijpvm_147_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Context: Postoperative sore throat (POST) is a common annoying problem following endotracheal (ET) intubation. Aims: Comparing the impact of low and high doses of ketamine gargle on lowering POST incidence and severity. Settings and Design: 96 patients selected for septoplasty surgery under general anesthesia were investigated through a single-blind randomized controlled trial. Methods: This study was performed on three equal groups. Group K and G gargled 50 and 100 mg ketamine, respectively, solved in normal saline and group C gargled pure normal saline for 30 s at 5 min before tracheal intubation. POST severity measured immediately after the entrance to the postanesthetic care unit (PACU) and then 2 h, 4 h, 8 h, and 24 h after operation. Statistical Analysis Used: Collected data were analyzed by the Chi-square test, Mann-Whitney test, Kruskal-Wallis test, one-way analysis of variance (ANOVA) and Friedman test using SPSS version 20. Results: POST incidence and severity in group C were significantly higher than both K and G groups at all times. Although significant differences between low and high doses of ketamine were acknowledged at 8 h post-operation, 100 mg ketamine could attenuate POST severity further than 50 mg at all times. Conclusions: It seems that 100 mg outperformed 50 mg ketamine without rising complications and dissatisfaction for subjects. So, it gives us a powerful reason to suggest gargling 100 mg ketamine for lessening POST incidence and severity.
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Affiliation(s)
- Dorna Kheirabadi
- Anesthesiology and Critical Care Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sobhan Ardekani
- General Physician, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Safavi
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elnaz Salmasi
- School of Medicine, Najaf Abad University of Medical Sciences, Isfahan, Iran
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Tsukamoto M, Taura S, Hitosugi T, Yokoyama T. A Case of Laryngeal Granulomas After Oral and Maxillofacial Surgery With Prolonged Intubation. Anesth Prog 2021; 68:94-97. [PMID: 34185856 DOI: 10.2344/anpr-68-01-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Abstract
Laryngeal granuloma development can be a postoperative complication of laryngeal trauma or irritation resulting from general anesthesia and endotracheal intubation. These rare benign lesions are located primarily over the cartilaginous portions of the larynx, particularly the vocal processes of the arytenoids. Airway manipulation during the intubation process and prolonged intubation periods can be contributing factors to intubation-related laryngeal granulomas, which may manifest 1 to 4 months after intubation. The patient in this case was a female who returned with complaints of throat pain without hoarseness or sensations of a "lump in her throat" 3 months following surgery, during which she was intubated with a 7.0-mm nasotracheal tube for 30 hours, likely contributing to her bilateral laryngeal granulomas. The patient underwent successful conservative medical management consisting of a proton pump inhibitor and an inhaled corticosteroid.
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Affiliation(s)
- Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Shiori Taura
- Department of Dental Anesthesiology, Graduate School of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takashi Hitosugi
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Park JH, Lee HJ, Lee SH, Kim JS. Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck: A randomized clinical trial. Medicine (Baltimore) 2021; 100:e26633. [PMID: 34398020 PMCID: PMC8294867 DOI: 10.1097/md.0000000000026633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Endotracheal tube (ETT) with a tapered-shaped cuff had an improved sealing effect when compared to ETTs with a conventional cylindrical-shaped cuff. Positional change and neck movement typically displace an ETT and change the intracuff pressure. The aim of the current study was to compare the ETT cuff pressure in the TaperGuard ETT vs the conventional ETT after a change from the supine, neutral position to the extension of the neck and semi-Fowler position for thyroid surgery. METHODS This prospective, randomized clinical trial included 50 patients undergoing thyroidectomy. Patients were randomly allocated into one of the 2 groups: tracheal intubation with the TaperGuard ETT or with a conventional ETT. The ETT cuff was inflated with air and the ETT cuff pressure was set initially at 20 cmH2O using a calibrated cuff manometer. ETT cuff pressure and distance from carina to ETT tip were measured at supine and semi-Fowler positions with neck extension. RESULTS After the position change, the ETT tip migrated cephalad and cuff pressure increased in the majority of cases. ETT cuff pressure was significantly higher in the TaperGuard group than the conventional group (28.0 ± 6.6 cmH2O and 22.8 ± 4.5 cmH2O, respectively, P = .001). The degree of cephalad displacement of the ETT tip was comparable between the 2 groups (19.4 ± 6.31 mm in TaperGuard group and 21.9 ± 6.9 mm in conventional group, P = .12). CONCLUSIONS After the position change from supine to hyperextension of the neck, the ETT cuff pressure was higher in the TaperGuard ETT than in the conventional ETT, although the extent of displacement of the ETT was comparable between the 2 groups.
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Comparison of endotracheal tube cuff pressures inflated with saline or air in gynecological laparoscopic surgery. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.942649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Delorenzo A, Shepherd M, Andrew E, Jennings P, Bernard S, Smith K. Endotracheal Tube Intracuff Pressure Changes in Patients Transported by a Helicopter Emergency Medical Service: A Prospective Observational Study. Air Med J 2021; 40:216-219. [PMID: 34172227 DOI: 10.1016/j.amj.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The pressure within an endotracheal tube cuff is of particular importance in helicopter emergency medical services (HEMS) transport because the unpressurized cabin is subjected to decreases in atmospheric pressure. This can cause the cuff to overinflate and may be associated with clinical complications. We sought to evaluate endotracheal tube cuff pressure changes among intubated patients during HEMS transport. METHODS A prospective observational study was performed including adult patients who were intubated and transported by helicopter between April 2017 and October 2018. Cuff pressures were measured before, during, and after HEMS transport with a commercial manometer. RESULTS A total of 208 patients were included. The median maximum flight altitude was 3,000 (interquartile range [IQR], 2,000-5,000) ft. The median initial cuff pressure before takeoff was 35 (IQR, 24-50) cm H2O, which increased to 50 (IQR, 35-70) cm H2O at maximum altitude. A total of 169 (81.3%) patients had a cuff pressure > 30 cm H2O at maximum altitude. There was a moderate correlation between altitude and cuff pressure (r = 0.532, P < .001). CONCLUSIONS Cuff pressure increased during HEMS transport, demonstrating the need for routine cuff pressure monitoring during flight. Further research is required to determine if exposure to transient increases in cuff pressure for short durations is clinically significant.
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Affiliation(s)
- Ashleigh Delorenzo
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia.
| | - Matthew Shepherd
- Ambulance Victoria, Victoria, Australia; Department of Paramedicine, Monash University, Victoria Australia
| | - Emily Andrew
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia
| | - Paul Jennings
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia; Department of Paramedicine, Monash University, Victoria Australia
| | - Stephen Bernard
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia; The Alfred Hospital, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria Australia; Department of Paramedicine, Monash University, Victoria Australia
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van Zundert A, Lee J, Reynolds H. Intraoperative cuff pressure measurements of endotracheal tubes in the operating theater: A prospective audit. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Borde DP, Pande S, Asegaonkar B, Khade S, George A, Joshi S. Does the endotracheal tube cuff pressure increases with transesophageal probe insertion? Ann Card Anaesth 2020; 23:460-464. [PMID: 33109804 PMCID: PMC7879908 DOI: 10.4103/aca.aca_52_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: The cuff pressure (CP) of the endotracheal tube (ETT) exceeding 30 cm of H2O results in reduced perfusion of lateral mucosa of trachea leading to complications. As the posterior tracheal wall is in contact with the esophagus, there is a possibility that the insertion of transesophageal echo (TEE) probe may compress the tracheal wall and increase CP. Aims: This study was aimed to assess the impact of TEE probe insertion on CP in adults undergoing cardiac surgery. Settings and Design: Prospective observational study of 65 patients at tertiary care level hospital. Subjects and Methods: After balanced general anesthesia, patients were intubated with high volume low-pressure ET.TEE probe was then inserted with gentle jaw thrust. CP was measured by standard invasive pressure monitoring device at four points: T1 at baseline before TEE probe insertion; T2 maximum CP noted at TEE probe insertion; T3 at 5 min post TEE probe insertion; and T4 at post-TEE exam. Statistical Analysis Used: CP was compared between pairs of time points (T1 vs. T2; T1 vs. T3; and T1 vs. T4) using Mann-Whitney U test. Factors predicting CP >30 cm of H2O at T4 were assessed by backward stepwise regression. Results: CP (mean ± S.D.) at T1, T2, T3, and T4 was 22 ± 3, 38 ± 10, 30 ± 6, and 30 ± 7, respectively. CP increased significantly from T1 to T2 (P < 0.001), T1 to T3 (P < 0.001), and T1 to T4 (P < 0.001). There were 26 patients (40%) with CP >30 cm of H2O at end of TEE exam (T4). On multivariate analysis baseline, CP (T1) >20 cm of H2O was significantly associated with CP >30 cm of H2O at end of TEE exam with Odd's Ratio (OR) of 8.5 (1.76–41.06, P = 0.008). Conclusions: To conclude, the CP increases significantly with TEE probe insertion in 40% of patients exceeding a safe limit of 30 cm of H2O. The monitoring and optimization of CP is advisable.
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Affiliation(s)
- Deepak Prakash Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Swati Pande
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Sujit Khade
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Antony George
- Department of Cardiac Anesthesia, Lissie Hospital, Kochi, Kerala, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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Benzidi Y, Duburcq T, Mathieu D, Parmentier-Decrucq E. Evaluation of pressure in water-filled endotracheal tube cuffs in intubated patients undergoing hyperbaric oxygen treatment. Diving Hyperb Med 2020; 50:230-237. [PMID: 32957124 DOI: 10.28920/dhm50.3.230-237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Inflating endotracheal tube cuffs using water instead of air before hyperbaric oxygen treatment (HBOT) is common. The objective of this study was to assess cuff pressure (Pcuff), when the cuff was inflated using water, in normobaric conditions and during HBOT. METHODS This was a prospective, observational study taking place in hyperbaric centre and intensive care unit of the University Hospital of Lille. Every patient who required tracheal intubation and HBOT at 253.3 kPa (2.5 atmospheres absolute [atm abs]) was included. Pcuff was measured using a pressure transductor connected to the cuff inflating port. Measurements were performed at 'normobaria' (1 atm abs) and during HBOT at 2.5 atm abs. RESULTS Thirty patients were included between February and April 2016. Recordings were analysable in 27 patients. Mean Pcuff at normobaria was 60.8 (SD 42) cmH2O. Nineteen (70%) of patients had an excessive Pcuff (higher than 30 cmH2O). Coefficient of variation was 69%. Mean Pcuff at 2.5 atm abs was 51.6 (40.7) cmH2O, significantly lower than at normobaria (P < 0.0001). Coefficient of variation was 79%. In only five (18%) patients was Pcuff < 20 cmH2O at 2.5 atm abs. CONCLUSIONS In normobaric conditions, when the cuff was inflated using water and not specifically controlled Pcuff was not predictable. The cuff was typically over-inflated exceeding safe pressure. During HBOT Pcuff decreased slightly.
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Affiliation(s)
- Younès Benzidi
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France.,Corresponding author: Erika Parmentier-Decrucq, Pôle de Réanimation Médicale, Hôpital Salengro, CHU, 2 rue Emile Laisne, 59037 Lille cedex, France,
| | - Thibault Duburcq
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
| | - Daniel Mathieu
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
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Won D, Chang JE, Kim H, Lee JM, Oh Y, Hwang JY. Effect of intraoperative neuromuscular blockade on postoperative sore throat and hoarseness in patients undergoing spinal surgery: a prospective observational study. Sci Rep 2020; 10:14810. [PMID: 32908175 PMCID: PMC7481207 DOI: 10.1038/s41598-020-71897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022] Open
Abstract
Intraoperative neuromuscular blockade affects the resting tension between the vocal cords. We assessed the effect of neuromuscular blockade on postoperative sore throat and hoarseness following tracheal intubation in patients undergoing lumbar spinal surgery in the prone position. Altogether, 99 patients were included; 50 patients did not receive neuromuscular blockade, and 49 patients received moderate neuromuscular blockade during the maintenance of anesthesia. Neuromuscular blockade was performed depending on the use of intraoperative neurophysiological monitoring. The number of intubation attempts, time to achieve tracheal intubation, and duration of intubation were recorded accordingly. The incidence and severity of postoperative sore throat and hoarseness was assessed at 1, 6, and 24 h after surgery. The overall cumulative incidence of postoperative sore throat (60% vs. 59%, respectively; P = 1.000) and postoperative hoarseness (68% vs. 61%, respectively; P = 0.532) did not differ between the no neuromuscular blockade and moderate neuromuscular blockade. The incidence and severity of postoperative sore throat and hoarseness was also not different between the moderate and no neuromuscular blockade at each time point after surgery. Nevertheless, the incidences of postoperative sore throat and hoarseness were quite high. Further studies investigating strategies to alleviate them are warranted accordingly.
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Affiliation(s)
- Dongwook Won
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Yoomin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea.
- College of Medicine, Seoul National University, Seoul, Republic of Korea.
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耿 志, 高 为, 王 东. [Clinical outcomes of vocal fold immobility after tracheal intubation]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 53:337-340. [PMID: 33879908 PMCID: PMC8072416 DOI: 10.19723/j.issn.1671-167x.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia. METHODS We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed. RESULTS A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge. CONCLUSION Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
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Affiliation(s)
- 志宇 耿
- 北京大学第一医院麻醉科，北京 100034Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China
| | - 为华 高
- 北京大学第一医院耳鼻喉与头颈外科，北京 100034Department of Otolaryngology-Head and Neck Surgery, First Hospital, Peking University, Beijing 100034, China
| | - 东信 王
- 北京大学第一医院麻醉科，北京 100034Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China
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Park HY, Kim M, In J. Does the minimal occlusive volume technique provide adequate endotracheal tube cuff pressure to prevent air leakage?: a prospective, randomized, crossover clinical study. Anesth Pain Med (Seoul) 2020; 15:365-370. [PMID: 33329837 PMCID: PMC7713835 DOI: 10.17085/apm.20020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/05/2020] [Accepted: 04/11/2020] [Indexed: 12/02/2022] Open
Abstract
Background Methods of determining proper endotracheal tube (ETT) cuff pressure to prevent air leakage include the minimal occlusive volume (MOV) technique, which uses auscultation, and the spirometer technique, which directly measures inspiratory and expiratory breathing volumes. Spirometers may measure even small air leakage, therefore, the spirometer technique requires a higher cuff pressure than the MOV technique to completely seal the airway. This study aimed to evaluate the difference in cuff pressure between the two techniques used to seal the airway. Methods Thirty-five female patients were intubated using an ETT with a cuff, and cuff inflation was performed with both techniques at a 10-min interval in random order—the MOV technique and then the spirometer technique or vice versa. The cuff pressure was measured at each period. Results The cuff pressures were 16.7 ± 4.4 cmH2O and 18.7 ± 5.2 cmH2O for the MOV and spirometer techniques, respectively. The cuff pressure for the spirometer technique was 2.0 cmH2O higher than that for the MOV technique and this difference was statistically significant (95% confidence interval, 0.7–3.3; P = 0.003). Considering the upper end (3.3 cmH2O) of the 95% confidence interval and the size of one scale unit (2.0 cmH2O) of a manometer, the difference in cuff pressure was up to 4 cmH2O in practice. Conclusions Even though the air leakage sound disappears on auscultation, unlike the previous recommendation, the airway sealing would be completed only by increasing the cuff pressure by approximately 4 cmH2O.
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Affiliation(s)
- Ha Yeon Park
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Mina Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol 2020; 278:1-7. [PMID: 32506145 PMCID: PMC7275663 DOI: 10.1007/s00405-020-06112-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae. MATERIALS AND METHODS This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers. RESULTS A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context. CONCLUSIONS One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.
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Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia 2020; 75:1529-1539. [PMID: 32415788 DOI: 10.1111/anae.15041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7-7.5 mm and 8-8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6-6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim-line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator-induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe peri-operative management.
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Affiliation(s)
- S Karmali
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - P Rose
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
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Şahbaz M, Khorshid L. The Effect of Cold Vapor and Ice Cube Absorption in the Early Postoperative Period on Sore Throat and Hoarseness Induced by Intubation. J Perianesth Nurs 2020; 35:518-524. [PMID: 32402773 DOI: 10.1016/j.jopan.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to determine the effect of cold vapor and ice cube absorption in the early postoperative period on sore throat and hoarseness induced by intubation. DESIGN This is a randomized controlled experimental study. METHODS Four groups (n = 30) were involved in the study: cold vapor application (group 1), ice cube absorption (group 2), ice cube absorption along with cold vapor application (group 3), and a control group (group 4). The sample consisted of 120 participants. The data were collected using the visual analog scale (VAS) and Stout's hoarseness scale postextubation (zeroth hour) and at the second, sixth, and 24th hours. FINDINGS After the interventions, the mean VAS scores for sore throat at the sixth postoperative hour were found to be 1.50 ± 1.71, 1.16 ± 1.08, and 1.30 ± 1.62 in group 1, group 2, and group 3, respectively. The mean VAS score for sore throat of group 4 was found to be 3.70 ± 1.89. The decrease in the VAS score for the sixth postoperative hour was ranked from highest to lowest as follows: ice cube absorption group, ice cube absorption along with cold vapor application group, and cold vapor application group. There was no significant difference between application groups in terms of mean VAS scores; however, it was found that mean VAS scores of all application groups were lower than that of control group, and there was a significant difference between them (P < .05). We found that at the sixth postoperative hour after intervention, 33.3% of group 1, 36.7% of group 2, 30% of group 3, and 46.7% of group 4 had hoarseness. No significant difference was found between groups, in terms of hoarseness scores of patients in the sixth postoperative hour after intervention (P > .05). CONCLUSIONS Cold vapor application, ice cube absorption, and ice cube absorption along with cold vapor application were effective in reducing sore throat but were ineffective as treatment for hoarseness.
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Affiliation(s)
- Muazzez Şahbaz
- Department of Fundamentals of Nursing, Nursing Faculty, Aydın Adnan Menderes University, Aydın, Turkey.
| | - Leyla Khorshid
- Department of Fundamentals of Nursing, Nursing Faculty, Ege University, İzmir, Turkey
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