Advertisement

Changes in endotracheal tube intracuff pressure and air leak pressure over time in anesthetized Beagle dogs

      Abstract

      Objective

      To evaluate endotracheal tube intracuff pressure (Pcuff) changes over time and the effect of these changes on air leak pressure (Pleak).

      Study design

      Prospective experimental study.

      Animals

      A group of nine healthy adult Beagle dogs.

      Methods

      In part I, in vitro measurements of Pcuff were recorded for 1 hour in eight endotracheal tubes subjected to four treatments: room temperature without lubricant (RT0L), room temperature with lubricant (RTWL), body temperature without lubricant (BT0L), and body temperature with lubricant (BTWL). In part II, nine dogs were endotracheally intubated and Pleak was evaluated at Pcuff of 25 mmHg. Subsequently, Pcuff was reset to 25 mmHg (baseline) and Pcuff measurements were recorded every 5 minutes for 1 hour. Subsequently, a second Pleak measurement was recorded at the current Pcuff. The data were analyzed using Wilcoxon signed-rank test, repeated measures anova and Mann–Whitney U test.

      Results

      In part I, Pcuff differed significantly between the RT0L and RTWL treatments at 5–60 minutes, and between the BT0L and BTWL treatments at 5–35, 55 and 60 minutes (p < 0.05). In part II, compared with baseline pressures, mean Pcuff decreased to <18 mmHg at 10 minutes and significant decreases were recorded at 15–60 minutes (Pcuff range: 10.0 ± 4.9 to 13.4 ± 6.3 mmHg, mean ± standard deviation). Significant differences were observed between the first and second Pleak measurements (p = 0.034). Pleak decreased in six of nine dogs, was not changed in two dogs and increased in one dog.

      Conclusions and clinical relevance

      Significant decreases in Pcuff over time were measured. Pleak may decrease during anesthesia and increase the risk for silent pulmonary aspiration. The results indicate the need for testing Pcuff more than once, especially at 10 minutes after the onset of anesthesia.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Briganti A.
        • Portela D.A.
        • Barsotti G.
        • et al.
        Evaluation of the endotracheal tube cuff pressure resulting from four different methods of inflation in dogs.
        Vet Anaesth Analg. 2012; 39: 488-494
        • Clarke K.W.
        • Trim C.M.
        • Hall L.W.
        Anesthesia of the dog.
        in: Clarke K.W. Trim C.M. Hall L.W. Veterinary Anaesthesia. 11th edn. Saunders Elsevier, USA2014: 405-498
        • Dorsch J.A.
        • Dorsch S.E.
        Tracheal tubes.
        in: Dorsch J.A. Dorsch S.E. Understanding Anesthesia Equipment. 2nd edn. Williams and Wilkins, USA1984: 353-400
        • Dorsch J.A.
        • Dorsch S.E.
        Tracheal tube and associated equipment.
        in: Dorsch J.A. Dorsch S.E. Understanding Anesthesia Equipment. 5th edn. Lippincott Williams & Wilkins, USA2008: 561-628
        • Dugdale A.
        Anaesthetic breathing systems.
        in: Dugdale A. Veterinary Anaesthesia: Principles to Practice. Wiley-Blackwell, USA2010: 76-92
        • Finholt D.A.
        • Henry D.B.
        • Raphaely R.C.
        Factors affecting leak around tracheal tubes in children.
        Can Anaesth Soc J. 1985; 32: 326-329
        • Girling K.J.
        • Bedforth N.M.
        • Spendlove J.L.
        • Mahajan R.P.
        Assessing neuromuscular block at the larynx: the effect of change in resting cuff pressure and a comparison with video imaging in anesthetized humans.
        Anesth Analg. 1999; 88: 426-431
        • Gopalakrishnan S.
        • Barry N.
        • Rice J.
        • Tobias J.D.
        Cuffed endotracheal tubes in infants and children: a technique to continuously measure the intracuff pressure.
        Int J Pediatr Otorhinolaryngol. 2013; 77: 1135-1138
        • Hartsfield S.M.
        Airway management and ventilation.
        in: Tranquilli W.J. Thurmon J.C. Grimm K.A. Lumb & Jones' Veterinary Anesthesia and Analgesia. 4th edn. Blackwell Publishing, USA2007: 495-531
        • Kako H.
        • Goykhman A.
        • Ramesh A.S.
        • et al.
        Changes in intracuff pressure of a cuffed endotracheal tube during prolonged surgical procedures.
        Int J Pediatr Otorhinolaryngol. 2015; 79: 76-79
        • Krishna S.G.
        • Ramesh A.S.
        • Jatana K.R.
        • et al.
        A technique to measure the intracuff pressure continuously: an in vivo demonstration of its accuracy.
        Pediatr Anesth. 2014; 24: 999-1004
        • Laflamme D.
        Development and validation of a body condition score system for dogs.
        Canine Pract. 1997; 22: 10-15
        • Mosley C.A.
        Anesthesia equipment.
        in: Grimm K.A. Tranquilli W.J. Lamont L.A. Essentials of Small Animal Anesthesia and Analgesia. 2nd edn. Wiley-Blackwell, UK2011: 158-196
        • Mosley C.A.
        Anesthesia equipment.
        in: Grimm K.A. Lamont L.A. Tranquilli W.J. Lumb & Jones' Veterinary Anesthesia and Analgesia. 5th edn. Wiley-Blackwell, USA2015: 23-85
        • Muir W.W.
        • Hubbell J.A.E.
        • Bednarski R.M.
        • Lerche P.
        Equipment for tracheal intubation and securing the airway.
        in: Muir W.W. Hubbell J.A.E. Bednarski R.M. Lerche P. Handbook of Veterinary Anesthesia. 5th edn. Elsevier, USA2013: 202-209
        • Neto E.P.S.
        • Piriou V.
        • Durand P.G.
        • et al.
        Influence of temperature on tracheal tube cuff pressure during cardiac surgery.
        Acta Anaesthesiol Scand. 1999; 43: 333-337
        • Nseir S.
        • Brisson H.
        • Marquette C.
        • et al.
        Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors.
        Eur J Anaesthesiol. 2009; 26: 229-234
        • Shin C.W.
        • Son W.
        • Jang M.
        • et al.
        Selection of appropriate endotracheal tube size using thoracic radiography in Beagle dogs.
        Vet Anaesth Analg. 2018; 45: 13-21
        • Sole M.L.
        Changes in endotracheal cuff pressures over time.
        Crit Care Med. 2002; 30: 144
        • Sole M.L.
        • Poalillo F.E.
        • Byers J.F.
        • et al.
        Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study.
        Am J Crit Care. 2002; 11: 141-149
        • Sole M.L.
        • Penoyer D.A.
        • Su X.
        • et al.
        Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study.
        Am J Crit Care. 2009; 18: 133-143
        • Sole M.L.
        • Su X.
        • Talbert S.
        • et al.
        Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range.
        Am J Crit Care. 2011; 20: 109-118
        • Stanley T.H.
        • Kawamura R.
        • Graves C.
        Effects of nitrous oxide on volume and pressure of endotracheal tube cuffs.
        Anesthesiology. 1974; 41: 256-262
        • Stewart S.L.
        • Secrest J.A.
        • Norwood B.R.
        • Zachary R.
        A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement.
        AANA J. 2003; 71: 443-447
        • Thomas J.A.
        • Lerche P.
        Canine and feline anesthesia.
        in: Thomas J.A. Lerche P. Anesthesia and Analgesia for Veterinary Technicians. 4th edn. Elsevier, USA2011: 233-264
        • Verma P.K.
        Care of tracheal tube cuff.
        in: Verma P.K. Principles and Practice of Critical Care. BI Publications Pvt Ltd, India2006: 7-9