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Indian Journal of Clinical Anaesthesia


COMPARISON OF MINIMAL LEAK TEST AND MANUAL CUFF PRESSURE MEASUREMENT TECHNIQUE METHOD FOR INFLATING THE ENDOTRACHEAL TUBE CUFF


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Author Details: Sambhunath Das, Pankaj Kumar

Volume : 2

Issue : 2

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 78

Article End Page : 81


Abstract

Background: Appropriate management of endotracheal tube (ETT) cuff pressure is essential during mechanical ventilation of an intubated patient. The ETT cuff should be inflated in order to seal the airway without volume loss or pharyngeal content aspiration. It is desirable that the cuff seal the airway without exerting high pressure on the trachea to compromise mucosal circulation. The aim of this study is to assess importance of monitoring of ETT cuff pressure in intubated patients and effect of intervention in preventing complications related to over and under inflation of ETT cuff .

Method: An observational prospective study performed between January and April 2015. All patients having cardiac surgery with cuffed ETT insertion were included. In Group1 cuff pressure manometer was used to monitor the cuff pressure and adjusted in the range of 20-30 cm H2O within 15 min before going on cardiopulmonary bypass. In Group2 only minimal leak test (MLT) done to guide inflation and cuff pressure measured by cuff pressure manometer but no intervention was made. Patients were followed in postsurgical care till extubation and observed till discharge for complication like sore throat, voice changes and tracheomalacia.
Results: In group 1 9(25.7%) patient had cuff pressure within normal limit whereas 25 (71.4%) patient had cuff pressure higher than normal and 1 (2.9%) patient had cuff pressure measurement less than 20 cm H2O. Volume of air added or removed from cuff was -0.89 ± 1.14 to optimize cuff pressure. Cuff pressure ranged from 15 to 120(47 ± 23) cm H2O.In group 2 11(32.4%) patient had cuff pressure within normal limit whereas 22 (64.7%) patients had cuff pressure higher than normal and 1 (2.9%) patient had cuff pressure measurement less than 20 cm H2O. Cuff pressure ranged from 18 to 100(47.4±20.3) cm H2O. In group 1, 11 patients developed hoarse voice compared to 32 patients in group 2. P=0.000 In group 1, 15 patient developed sore throat versus 21 patients in group 2, P = 0.187.
Conclusion: Measurements of endotracheal tube intra cuff pressure are essential to avoid over or under inflation of ETT cuff. Adjusting the cuff pressure to 20-30cmH2O will prevent volume loss during ventilation and complications like sore throat, hoarseness of voice and tracheomalacia. Measurement of cuff pressure with timely intervention should be made standard of care in operation theatre and ICU.
 
Keywords: Endotracheal tube cuff pressure, Minimal leak test, Minimum occlusive volume, Manual cuff pressure measurement, Cardiac surgery