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Do lower cuff pressures reduce damage to the tracheal? A scanning electron microscopy study in neonatal pigs


Kutter, A P N; Bittermann, A G; Bettschart-Wolfensberger, R; Spielmann, N; Hartnack, S; Ziegler, U; Weiss, M; Mauch, J Y (2013). Do lower cuff pressures reduce damage to the tracheal? A scanning electron microscopy study in neonatal pigs. Paediatric Anaesthesia, 23(2):117-121.

Abstract

BACKGROUND: Modern high volume-low pressure (HVLP) endotracheal tubes (ETT) cuffs can seal the trachea using baseline cuff pressures (CP) lower than peak inspiratory airway pressures (PIP). The aim of the study was to determine whether this technique reduces the damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O. METHODS: Eighteen piglets were intubated with an ID 4.0 mm HVLP cuffed ETT (Microcuff PET) and artificially ventilated with 20 cmH(2) O PIP and 5 cmH(2) O PEEP. Animals were randomly allocated to two groups of CP: group A (just seal; n = 9) and group B (20 cmH(2) O; n = 9), controlled constantly with a manometer during the following 4-h study period under sevoflurane anesthesia. After euthanasia, cuff position was marked in situ. Damage in the cuff region was evaluated with scanning electron microscopy (SEM) examination by grading of mucosal damage and by estimating percentage of intact mucosal area both by a blinded observer. RESULTS: Maximal CP to seal the trachea in group A ranged from 12 to 18 cmH(2) O (median: 14 cmH(2) O). Using a mixed effects model approach, the estimated mean effect of group B vs group A was an increase of 17.9% (SE 8.1%) higher proportion of pictures with an area of at least 5% intact mucosa (P = 0.042). CONCLUSION: Minimal sealing pressures with cyclic pressure changes from CP did not result in decreased damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O in this short-term animal trial.

BACKGROUND: Modern high volume-low pressure (HVLP) endotracheal tubes (ETT) cuffs can seal the trachea using baseline cuff pressures (CP) lower than peak inspiratory airway pressures (PIP). The aim of the study was to determine whether this technique reduces the damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O. METHODS: Eighteen piglets were intubated with an ID 4.0 mm HVLP cuffed ETT (Microcuff PET) and artificially ventilated with 20 cmH(2) O PIP and 5 cmH(2) O PEEP. Animals were randomly allocated to two groups of CP: group A (just seal; n = 9) and group B (20 cmH(2) O; n = 9), controlled constantly with a manometer during the following 4-h study period under sevoflurane anesthesia. After euthanasia, cuff position was marked in situ. Damage in the cuff region was evaluated with scanning electron microscopy (SEM) examination by grading of mucosal damage and by estimating percentage of intact mucosal area both by a blinded observer. RESULTS: Maximal CP to seal the trachea in group A ranged from 12 to 18 cmH(2) O (median: 14 cmH(2) O). Using a mixed effects model approach, the estimated mean effect of group B vs group A was an increase of 17.9% (SE 8.1%) higher proportion of pictures with an area of at least 5% intact mucosa (P = 0.042). CONCLUSION: Minimal sealing pressures with cyclic pressure changes from CP did not result in decreased damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O in this short-term animal trial.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Clinic for Surgery
05 Vetsuisse Faculty > Chair in Veterinary Epidemiology
05 Vetsuisse Faculty > Veterinary Clinic > Equine Department
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Date:2013
Deposited On:12 Nov 2012 10:07
Last Modified:05 Apr 2016 16:04
Publisher:Wiley-Blackwell
ISSN:1155-5645
Publisher DOI:10.1111/pan.12066
PubMed ID:23137044
Permanent URL: http://doi.org/10.5167/uzh-66408

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