If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
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E-letters: Electronic letters published:
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Tracheal Surface Alterations
- John George George Cherian (10 January 2008)
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Exploratory Endoscopy to Gauge Post-intubation Tracheal Surface Alterations
- John George George Cherian (5 October 2007)
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Re: Intra-cuff pressure measurement with Curity tube
- Keith B. Greenland (27 September 2007)
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Intra-cuff pressure measurement with Curity tube
- John George George Cherian (25 September 2007)
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John George George Cherian Fellow - Malaysian Institute of Medical Laboratory Sciences
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Sirs We would like to know the current pulmonary status of patients in the clinical trial and in particular if there were any signs of pathology such as surface alterations in areas impacted by the cuffs of the endotracheal tubes used. Tracheal ischaemia leading to necrosis is known to manifest, secondary to intubation, with hyper-pressured cuffs. On the other hand if endotracheal tube cuff pressures were minimal and below sealing point, aspiration with the attendant threat of lower respiratory tract infection would have been thought of as likely prognosis. Kind regards John George Conflict of Interest:Some patients are more susceptible to exessive cuff pressures than others and it is in the interest of patient-safety that we question the current status of patients in the trial |
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John George George Cherian Fellow-Malaysian Institute of Medical Laboratory Sciences
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Sirs, In the interest of patient-safety, if the 'minimum occlusion pressure (MOP)technique' was the choice of intra-cuff pressure maintenance during anaesthesia employing the Kendall Curity tube, it would be incumbent to perform exploratory tracheal endoscopy to identify possible surface alterations induced by hyper-pressured cuffs post-extubation. If 'MOP' was not employed, it follows that cuffs were likely not hyper-pressured during anaesthesia. The possibility, then, of episodes of gastric aspiration occuring should not be ruled out, given that the cuffs of these tubes were highly suspect of requiring between 70-80cm H20 pressure to effect an adequate tracheal seal. This level of hyper-pressure (taking 80 cm H20 as the upper limit) would be approximately 66% beyond the generally-accepted patient-safety-limit of 30cm H20. What is the current pulmonary status of patients intubated with the Kendall Curity tubes ? Thank you. John George - Fellow, Malaysian Institute of Medical Laboratory Sciences; Correspondence: 4 Lrg 4/48 F, 46050 , PJ, Selangor , Malaysia Conflict of Interest:None declared |
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Keith B. Greenland
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Dear Dr. Cherian, Though I appreciate your concerns with the Kendel Curity tube, our study did not measure the cuff measure when it was inflated. Our study focused in part on the lengths of various parts of this and other tracheal tubes. The Kendel Curity tracheal tube is not our usual choice for clinical work. We included it in this study because it was one of many commonly used tracheal tubes at the time. We are therefore not in a position to support or contradict your assertions. Regards, Dr. Keith Greenland Conflict of Interest:None declared |
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John George George Cherian Fellow- Malaysian Institute of Medical Laboratory Sciences
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Sirs, Minimum occlusion pressures of the tubes should have been factored into the study as they clearly contribute towards the risk factors of ischaemia and necrosis in intubated patients. Severe stenosis induced by hyper-pressured cuffs often are subjected to treatment modalities of tracheal resection and reconstruction with questionable success rates. In Chong's study, Kendal Curity tubes are reported to have been used and last year (2006) these tubes were highly suspect of requiring excessive intracuff pressures (between 70-80 cm H20) to provide a seal. Under these conditions intubated patients would have likely been placed at high risk of tracheal ischaemia and its corresponding pathophysiology. Regards John George Fellow - Malaysian Institute of Medical Laboratory Sciences 4 Lrg 4/48 F 46050 PJ Selangor , Malaysia Conflict of Interest:None declared |
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