Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Samina Mir

doi:doi:10.11648/j.ijacm.20231101.19

| Peer-Reviewed

Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Samina Mir

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)

Received: 2 May 2023 Accepted: 18 May 2023 Published: 6 June 2023

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH₂O to 110 cmH₂O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH₂O, 23% of patients had normal cuff pressure between 20 to 30 cmH₂O, and 63% had more than normal pressure which was more than 30 cmH₂O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH₂O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH₂O.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI	10.11648/j.ijacm.20231101.19
Page(s)	38-43
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Endotracheal Intubation, General Anesthesia, Cuff Pressure Measurement, Cuff Volume Assessment

References

[1]	Nseir S, Brisson H, Marquette CH, Chaud P, Di Pompeo C, Diarra M, et al. Variations in endotracheal cuff pressure in intubated critically ill patients: Prevalence and risk factors. Eur J Anaesthesiol 2009; 26: 229-34. [PUBMED].
[2]	Blot SI, Poelaert J, Kollef M. How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis 2014; 14: 119. [PUBMED].
[3]	American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416. [PUBMED].
[4]	Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med 2005; 33: 2184-93. [PUBMED].
[5]	Rubes D, Klein AA, Lips M, Rulisek J, Kopecky P, Blaha J, et al. The effect of adjusting tracheal tube cuff pressure during deep hypothermic circulatory arrest: A randomised trial. Eur J Anaesthesiol 2014; 31: 452-6. [PUBMED].
[6]	Stewart SL, Secrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003; 71 (6): 443–7. [PUBMED] [G00GLE SCHOLAR].
[7]	Fernandez R, Blanch L, Mancebo J, Bonsoms N, Artigas A. Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement. Crit Care Med. 1990; 18 (12): 1423–6. [PUB MED] [G00GLE SCHOLAR].
[8]	Trivedi L, Jha P, Bajiya NR, Tripathi D. We should care more about intracuff pressure: The actual situation in government sector teaching hospital. Indian J Anaesth. 2010; 54 (4): 314–7. doi: 10.4103/0019-5049.68374. [PMC free article] [PEB MED] [CROSS REF] [G00GLE SCHOLAR].
[9]	Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006; 24 (2): 139–43. doi: 10.1016/j.ajem.2005.07.016. [PEB MED] [CrossRef] [Google Scholar].
[10]	Svenson JE, Lindsay MB, O'Connor JE. Endotracheal intracuff pressures in the ED and prehospital setting: is there a problem? Am J Emerg Med. 2007; 25 (1): 53–6. doi: 10.1016/j.ajem.2006.09.001. [PubMed] [CrossRef] [Google Scholar].
[11]	Galinski M, Treoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med. 2006; 47 (6): 545–7. doi: 12. Ozer AB.
[12]	Demirel I, Gunduz G, Erhan OL. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure. Niger J Clin Pract. 2013; 16 (2): 253–7. doi: 10.4103/1119-3077.110139. [PubMed] [CrossRef] [Google Scholar].
[13]	Wujtewicz MA, Sawicka W, Owczuk R, Dylczyk-Sommer A, Wujtewicz M. Tracheal tube cuff pressure depends on the anaesthesiologist's experience. A follow-up study. Anestezjol Intens Ter. 2009; 41 (4): 205–8. [PubMed] [Google Scholar].
[14]	Bernhard WN, Yost L, Joynes D, Cothalis S, Turndorf H. Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics. Chest 1985; 87: 720-5. [PUBMED].
[15]	Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: A multicenter study. Anesth Analg 2010; 111: 1133-7. [PUBMED].
[16]	Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: Endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed) 1984; 288: 965-8. [PUBMED].
[17]	Stein C, Berkowitz G, Kramer E. Assessment of safe endotracheal tube cuff pressures in emergency care – Time for change? S Afr Med J 2011; 101: 172-3. [PUBMED].
[18]	Sultan P, Carvalho B, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: A review of the evidence. J Perioper Pract 2011; 21: 379-86. [PUBMED].
[19]	Taoyuan Robert Feng, Ying Ye, D John Doyle, Critical importance of tracheal tube cuff pressure management, World J Anesthesiol 2015 July 27; 4 (2): 10-1.
[20]	Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol 2004; 4: 8.
[21]	Harm F, Zuercher M, Bassi M, Ummenhofer W. Prospective observational study on tracheal tube cuff pressures in emergency patients – Is neglecting the problem the problem? Scand J Trauma Resusc Emerg Med 2013; 21: 83. [PUBMED].
[22]	Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery - Manual vs. automatic method. J Anaesthesiol Clin Pharmacol 2011; 27: 358-361 [PMID: 21897508 DOI: 10.4103/0970-9185.83682] 11 Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani.
[23]	J, Wadhwa A. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol 2004; 4: 8 [PMID: 15569386 DOI: 10.1186/1471-2253-4-8].
[24]	Loeser EA, Orr DL, Bennett GM, Stanley TH. Endotracheal tube cuff design and postoperative sore throat. Anesthesiology 1976; 45: 684-687 [PMID: 984490].
[25]	De S, De S. Post intubation tracheal stenosis. Indian J Crit Care Med 2008; 12: 194-197 [PMID: 19742266 DOI: 10.4103/0972-5229.45081].
[26]	Luna CM, Legarreta G, Esteva H, Laffaire E, Jolly EC. Effect of tracheal dilatation and rupture on mechanical ventilation using a low-pressure cuff tube. Chest 1993; 104: 639-640 [PMID: 8339669].
[27]	Striebel HW, Pinkwart LU, Karavias T. [Tracheal rupture caused by overinflation of endotracheal tube cuff]. Anaesthesist 1995; 44: 186-188 [PMID: 7762778] 2.
[28]	Nordin U. The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl 1977; 345: 1-71 [PMID: 335778].
[29]	Dikkers FG. Tracheal stenosis can occur 20 years after intubation. BMJ 2001; 322: 362 [PMID: 11273242].
[30]	Wain JC. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg 2009; 21: 284-289 [PMID: 19942129 DOI: 10.1053/ j.semtcvs.2009.08.001].
[31]	Diaz E, Rodríguez AH, Rello J. Ventilator-associated pneumonia: issues related to the artificial airway. Respir Care 2005; 50: 900-906; discussion 906-909 [PMID: 15972111].

Cite This Article

Plain Text BibTeX RIS

APA Style

Samina Mir. (2023). Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. International Journal of Anesthesia and Clinical Medicine, 11(1), 38-43. https://doi.org/10.11648/j.ijacm.20231101.19

Copy | Download

ACS Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int. J. Anesth. Clin. Med. 2023, 11(1), 38-43. doi: 10.11648/j.ijacm.20231101.19

Copy | Download

AMA Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int J Anesth Clin Med. 2023;11(1):38-43. doi: 10.11648/j.ijacm.20231101.19

Copy | Download

@article{10.11648/j.ijacm.20231101.19,
  author = {Samina Mir},
  title = {Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {38-43},
  doi = {10.11648/j.ijacm.20231101.19},
  url = {https://doi.org/10.11648/j.ijacm.20231101.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.19},
  abstract = {Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery
AU  - Samina Mir
Y1  - 2023/06/06
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.19
DO  - 10.11648/j.ijacm.20231101.19
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.19
AB  - Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.
VL  - 11
IS  - 1
ER  -

Copy | Download

Author Information

Samina Mir

Department of Anaesthesia, Aga Khan University, Nairobi, Kenya

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Samina Mir. (2023). Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. International Journal of Anesthesia and Clinical Medicine, 11(1), 38-43. https://doi.org/10.11648/j.ijacm.20231101.19

Copy | Download

ACS Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int. J. Anesth. Clin. Med. 2023, 11(1), 38-43. doi: 10.11648/j.ijacm.20231101.19

Copy | Download

AMA Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int J Anesth Clin Med. 2023;11(1):38-43. doi: 10.11648/j.ijacm.20231101.19

Copy | Download

@article{10.11648/j.ijacm.20231101.19,
  author = {Samina Mir},
  title = {Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {38-43},
  doi = {10.11648/j.ijacm.20231101.19},
  url = {https://doi.org/10.11648/j.ijacm.20231101.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.19},
  abstract = {Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery
AU  - Samina Mir
Y1  - 2023/06/06
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.19
DO  - 10.11648/j.ijacm.20231101.19
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.19
AB  - Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.
VL  - 11
IS  - 1
ER  -

Copy | Download