Comparison of four inflation techniques on endotracheal tube cuff pressure using a feline airway simulator.

Abstract

OBJECTIVES: The aim of this study was to compare four inflation techniques on endotracheal tube cuff (ETC) pressure using a feline airway simulator. METHODS: Ten participants used four different endotracheal cuff inflation techniques to inflate the cuff of a low-pressure, high-volume endotracheal tube within a feline airway simulator. The simulator replicated an average-sized feline trachea, intubated with a 4.5 mm endotracheal tube, connected to a circle breathing system and pressure-controlled ventilation with oxygen and medical air. Participants inflated the ETC: by pilot balloon palpation (P); by instilling the minimum occlusive volume (MOV) required for loss of airway leaks during mechanical ventilation; until a passive release of pressure with use of a loss-of-resistance syringe (LOR); and with use of a syringe with a digital pressure reader (D) specifically designed for endotracheal cuff inflation. Intracuff pressure was measured by a manometer obscured to participants. The ideal pressure was considered to be between 20 and 30 cmHO. Data were analysed by Shapiro-Wilk, Kruskal-Wallis and &#x3c7;tests, as appropriate. RESULTS: Participants were eight veterinarians and two veterinary nurses with additional training in anaesthesia. Measured median intracuff pressures for P, MOV, LOR and D, respectively, were 25 cmHO (range 4-74 cmHO), 41 cmHO (range 4-70 cmHO), 31 cmHO (range 18-64 cmHO) and 22 cmHO (range 20-30 cmHO). D performed significantly better (<0.001) than all other techniques, with no difference between the other techniques. CONCLUSIONS AND RELEVANCE: Use of D for cuff inflation achieved optimal cuff pressures. There may be high operator-dependent variability in the cuff pressures achieved with the use of P, MOV or LOR inflation techniques. As such, a cuff manometer is recommended when using any of these techniques.