BJA Advance Access originally published online on December 25, 2008
British Journal of Anaesthesia 2009 102(2):273-278; doi:10.1093/bja/aen355
Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes
1 Department of Anaesthesia
2 Department of Intensive Care and Neonatology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland
* Corresponding author. E-mail: markus.weiss{at}kispi.uzh.ch
Background: Cyclic redistribution of air within the cuff during respiratory pressure changes creates a self-sealing mechanism which allows tracheal sealing, despite tracheal airway pressure being above baseline cuff inflation pressure. The aim of the present study was to investigate the effect of continuous automated cuff pressure regulation on tracheal sealing during cyclic respiratory pressure changes.
Methods: In vitro tracheal sealing was studied in four different high volume–low pressure (HVLP) tracheal tube cuffs size internal diameter 8.0 and 5.0 mm in combination with a conventional pressure manometer and two different automated pressure controllers (VBM Cuff Controller; Cuff Pressure Control TracoeTM). Experiments were performed at 10, 15, 20, and 25 cm H2O cuff pressure during intermittent positive pressure ventilation with peak inspiratory pressures of 20 and 25 cm H2O. Air leakage was assessed spirometrically. Experiments were performed four times with each tube brand and size with two exemplars of each of the three cuff pressure controllers.
Results: Owing to immediate cuff pressure correction, tracheal sealing at cuff pressure below inspiratory pressure was reduced in most of the tracheal tube cuffs, except in those with reduced sealing characteristics when using the Pressure Control TracoeTM compared with the conventional pressure manometer and the VBM Cuff Controller. Tracheal sealing with the Pressure Control TracoeTM comparable with the other two devices was only achieved at cuff pressures of 20 and 25 cm H2O.
Conclusions: Automated cuff pressure controllers with rapid pressure correction interfere with the self-sealing mechanism of high sealing HVLP tube cuffs and reduce their improved sealing characteristics.
Keywords: airway; complications, aspiration; ventilation
Declaration of interest. The tracheal tubes and the cuff regulators studied were ordered from local distributors. No financial support was obtained from the manufacturers for the present study. No agreements or financial benefits arise from these co-operations. There are no financial or non-financial competing interests in the accomplishment of this study.
Read all E-letters
CiteULike 
Connotea 
Del.icio.us What's this?
E-letters: