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Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study.
Anesth Analg. 2010 Nov; 111(5):1133-7.A&A

Abstract

BACKGROUND

Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness, and blood-streaked expectorant. In this study, we investigated the short-term (hours) impact of measuring and controlling endotracheal tube cuff (ETTc) pressure on postprocedural complications.

METHODS

Five hundred nine patients from 4 tertiary care university hospitals in Shanghai, China scheduled for elective surgery under general anesthesia were assigned to a control group without measuring ETTc pressure, and a study group with ETTc pressure measured and adjusted. The duration of the procedure and duration of endotracheal intubation were recorded. Twenty patients whose duration of endotracheal intubation was between 120 and 180 minutes were selected from each group and examined by fiberoptic bronchoscopy immediately after removing the endotracheal tube. Endotracheal intubation-related complications including cough, sore throat, hoarseness, and blood-streaked expectorant were recorded at 24 hours postextubation.

RESULTS

There was no significant difference in sex, age, height, weight, procedure duration, and duration of endotracheal intubation between the 2 groups. The mean ETTc pressure measured after estimation by palpation of the pilot balloon of the study group was 43 ± 23.3 mm Hg before adjustment (the highest was 210 mm Hg), and 20 ± 3.1 mm Hg after adjustment (P < 0.001). The incidence of postprocedural sore throat, hoarseness, and blood-streaked expectoration in the control group was significantly higher than in the study group. As the duration of endotracheal intubation increased, the incidence of sore throat and blood-streaked expectoration in the control group increased. The incidence of sore throat in the study group also increased with increasing duration of endotracheal intubation. Fiberoptic bronchoscopy in the 20 patients showed that the tracheal mucosa was injured in varying degrees in both groups, but the injury was more severe in the control group than in the study group.

CONCLUSIONS

ETTc pressure estimated by palpation with personal experience is often much higher than measured or what may be optimal. Proper control of ETTc pressure by a manometer helped reduce ETT-related postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours).

Authors+Show Affiliations

Department of Anesthesiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20736432

Citation

Liu, Jianhui, et al. "Correlations Between Controlled Endotracheal Tube Cuff Pressure and Postprocedural Complications: a Multicenter Study." Anesthesia and Analgesia, vol. 111, no. 5, 2010, pp. 1133-7.
Liu J, Zhang X, Gong W, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010;111(5):1133-7.
Liu, J., Zhang, X., Gong, W., Li, S., Wang, F., Fu, S., Zhang, M., & Hang, Y. (2010). Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesthesia and Analgesia, 111(5), 1133-7. https://doi.org/10.1213/ANE.0b013e3181f2ecc7
Liu J, et al. Correlations Between Controlled Endotracheal Tube Cuff Pressure and Postprocedural Complications: a Multicenter Study. Anesth Analg. 2010;111(5):1133-7. PubMed PMID: 20736432.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. AU - Liu,Jianhui, AU - Zhang,Xiaoqing, AU - Gong,Wei, AU - Li,Shitong, AU - Wang,Fen, AU - Fu,Shukun, AU - Zhang,Mazhong, AU - Hang,Yannan, Y1 - 2010/08/24/ PY - 2010/8/26/entrez PY - 2010/8/26/pubmed PY - 2010/11/17/medline SP - 1133 EP - 7 JF - Anesthesia and analgesia JO - Anesth Analg VL - 111 IS - 5 N2 - BACKGROUND: Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness, and blood-streaked expectorant. In this study, we investigated the short-term (hours) impact of measuring and controlling endotracheal tube cuff (ETTc) pressure on postprocedural complications. METHODS: Five hundred nine patients from 4 tertiary care university hospitals in Shanghai, China scheduled for elective surgery under general anesthesia were assigned to a control group without measuring ETTc pressure, and a study group with ETTc pressure measured and adjusted. The duration of the procedure and duration of endotracheal intubation were recorded. Twenty patients whose duration of endotracheal intubation was between 120 and 180 minutes were selected from each group and examined by fiberoptic bronchoscopy immediately after removing the endotracheal tube. Endotracheal intubation-related complications including cough, sore throat, hoarseness, and blood-streaked expectorant were recorded at 24 hours postextubation. RESULTS: There was no significant difference in sex, age, height, weight, procedure duration, and duration of endotracheal intubation between the 2 groups. The mean ETTc pressure measured after estimation by palpation of the pilot balloon of the study group was 43 ± 23.3 mm Hg before adjustment (the highest was 210 mm Hg), and 20 ± 3.1 mm Hg after adjustment (P < 0.001). The incidence of postprocedural sore throat, hoarseness, and blood-streaked expectoration in the control group was significantly higher than in the study group. As the duration of endotracheal intubation increased, the incidence of sore throat and blood-streaked expectoration in the control group increased. The incidence of sore throat in the study group also increased with increasing duration of endotracheal intubation. Fiberoptic bronchoscopy in the 20 patients showed that the tracheal mucosa was injured in varying degrees in both groups, but the injury was more severe in the control group than in the study group. CONCLUSIONS: ETTc pressure estimated by palpation with personal experience is often much higher than measured or what may be optimal. Proper control of ETTc pressure by a manometer helped reduce ETT-related postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours). SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/20736432/Correlations_between_controlled_endotracheal_tube_cuff_pressure_and_postprocedural_complications:_a_multicenter_study_ L2 - https://doi.org/10.1213/ANE.0b013e3181f2ecc7 DB - PRIME DP - Unbound Medicine ER -