Low Pressure Cuff Tracheal Tubes

Abstract

Endotracheal tubes (ETT) with low pressure cuffs generate low ETT cuff pressures (ETCP) But at times ETCP can be in high and unsafe levels, which can cause ischaemic pressure damage of trachea. Aim of the study was to achieve safe levels of ETCP during operations. We prospectively studied ETCP in 80 patients undergoing elective cholecystectomy. After tracheal intubation the ETT cuff was inflated by the anaesthesia technician to the satisfaction of the attendant anaesthetist. ETCP was measured 10 minutes after intubation, if high it was brought down to 25cm H2O. Leak and reduction in expired tidal volume was looked for. Extra air was added to the cuff to correct this. ETCP was measured again. Safe levels of ETCP (25 cmH2O) were found in 47.5% patients. Unsafe levels of ETCP were found in 52.5% patients. When ETCP was adjusted down to 25cm H2O in these patients, it showed that another 45% patients could have had leak proof ventilation within the safe levels of ETCP. Only 7.5% patients needed slightly high levels (32.5cm H2O) of ETCP. High Volume Low Pressure (HVLP) cuff tracheal tubes can also generate high and unsafe ETCP. There is need to monitor ETCP regularly.