British Journal of Anaesthesia, Vol 82, Issue 5 708-711, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. Brimacombe, C. Keller, M. Giampalmo, H. J. Sparr and A. Berry
We measured directly mucosal pressures against the cuff and non-cuff
portions of the tracheal tube in different head-neck positions and tested
the reliability of calculated mucosal pressures, in vivo intracuff
pressures and cuff volume as determinants of directly measured mucosal
pressures. We studied 10 anaesthetized, paralysed adult patients. An
8.5-mm, high volume, low pressure PVC tracheal tube was used. Microchip
sensors were attached to three cuff locations (anterior, lateral and
posterior) and two non-cuff locations (anterior tip and anterior aspect of
the tube, 5 cm proximal to the cuff). Directly measured mucosal pressures,
in vivo intracuff pressures and calculated mucosal pressures (in vivo minus
in vitro intracuff pressures) were determined after brief inflation (<
15 s) to 0, 5, 10 and 15 ml. In vivo intracuff pressures were then set at
30 mm Hg and the measurements repeated, first in the neutral position and
then with the head-neck extended, flexed and rotated. Cuff mucosal
pressures were highest anteriorly and lowest posteriorly. Non-cuff mucosal
pressures did not vary with cuff volume and were approximately 15 mm Hg.
Compared with the neutral position, in vivo intracuff pressures were higher
in the rotated, extended and flexed positions. Compared with the neutral
position, mucosal pressure increased on the anterior aspect of the tube in
the flexed position by 22 mm Hg (P = 0.003), at the anterior tip in the
extended position by 11 mm Hg (P = 0.002) and at the anterior tip (5 mm Hg,
P = 0.05) and lateral aspect of the cuff (5 mm Hg, P = 0.03) in the rotated
position. In vivo intracuff pressures and calculated mucosal pressures were
moderate predictors of measured mucosal pressures; cuff volume was a poor
predictor. We conclude that tracheal mucosal pressures were highest
anteriorly, that non-cuff portions of the tube exerted substantial mucosal
pressures and that the rotated position caused a greater increase in
tracheal mucosal pressure than the extended or flexed position. Indirect
methods of measuring mucosal pressure were of moderate predictive value.
CLINICAL INVESTIGATIONS
Direct measurement of mucosal pressures exerted by cuff and non-cuff portions of tracheal tubes with different cuff volumes and head and neck positions
University of Queensland, Cairns Base Hospital, Cairns 4870, Australia; Cairns Base Hospital, Cairns 4870, Australia; Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, A-6020 Innsbruck, Austria; Department of Anaesthesia and Intensive Care, Policlinico Universitario Umberto I, Roma, Italy; Department of Anaesthesia and Intensive Care, Nambour General Hospital, Australia
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