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Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes - Zurich Open Repository and Archive


Weiss, M; Doell, C; Koepfer, N; Madjdpour, C; Woitzek, K; Bernet, V (2009). Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes. British Journal of Anaesthesia, 102(2):273-278.

Abstract

BACKGROUND: Cyclic redistribution of air within the cuff during respiratory pressure changes creates a self-sealing mechanism which allows tracheal sealing, despite tracheal airway pressure being above baseline cuff inflation pressure. The aim of the present study was to investigate the effect of continuous automated cuff pressure regulation on tracheal sealing during cyclic respiratory pressure changes. METHODS: In vitro tracheal sealing was studied in four different high volume-low pressure (HVLP) tracheal tube cuffs size internal diameter 8.0 and 5.0 mm in combination with a conventional pressure manometer and two different automated pressure controllers (VBM Cuff Controller; Cuff Pressure Control Tracoe). Experiments were performed at 10, 15, 20, and 25 cm H(2)O cuff pressure during intermittent positive pressure ventilation with peak inspiratory pressures of 20 and 25 cm H(2)O. Air leakage was assessed spirometrically. Experiments were performed four times with each tube brand and size with two exemplars of each of the three cuff pressure controllers. RESULTS: Owing to immediate cuff pressure correction, tracheal sealing at cuff pressure below inspiratory pressure was reduced in most of the tracheal tube cuffs, except in those with reduced sealing characteristics when using the Pressure Control Tracoe compared with the conventional pressure manometer and the VBM Cuff Controller. Tracheal sealing with the Pressure Control Tracoe comparable with the other two devices was only achieved at cuff pressures of 20 and 25 cm H(2)O. CONCLUSIONS: Automated cuff pressure controllers with rapid pressure correction interfere with the self-sealing mechanism of high sealing HVLP tube cuffs and reduce their improved sealing characteristics.

Abstract

BACKGROUND: Cyclic redistribution of air within the cuff during respiratory pressure changes creates a self-sealing mechanism which allows tracheal sealing, despite tracheal airway pressure being above baseline cuff inflation pressure. The aim of the present study was to investigate the effect of continuous automated cuff pressure regulation on tracheal sealing during cyclic respiratory pressure changes. METHODS: In vitro tracheal sealing was studied in four different high volume-low pressure (HVLP) tracheal tube cuffs size internal diameter 8.0 and 5.0 mm in combination with a conventional pressure manometer and two different automated pressure controllers (VBM Cuff Controller; Cuff Pressure Control Tracoe). Experiments were performed at 10, 15, 20, and 25 cm H(2)O cuff pressure during intermittent positive pressure ventilation with peak inspiratory pressures of 20 and 25 cm H(2)O. Air leakage was assessed spirometrically. Experiments were performed four times with each tube brand and size with two exemplars of each of the three cuff pressure controllers. RESULTS: Owing to immediate cuff pressure correction, tracheal sealing at cuff pressure below inspiratory pressure was reduced in most of the tracheal tube cuffs, except in those with reduced sealing characteristics when using the Pressure Control Tracoe compared with the conventional pressure manometer and the VBM Cuff Controller. Tracheal sealing with the Pressure Control Tracoe comparable with the other two devices was only achieved at cuff pressures of 20 and 25 cm H(2)O. CONCLUSIONS: Automated cuff pressure controllers with rapid pressure correction interfere with the self-sealing mechanism of high sealing HVLP tube cuffs and reduce their improved sealing characteristics.

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24 citations in Web of Science®
28 citations in Scopus®
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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
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:24 Nov 2009 10:05
Last Modified:05 Apr 2016 13:34
Publisher:Oxford University Press
ISSN:0007-0912
Publisher DOI:https://doi.org/10.1093/bja/aen355
PubMed ID:19112060

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