Regulation of Intracuff Pressure by Measurement of the Ratio of Expiratory to Inspiratory Tidal Volumes.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2025-11-01 Epub Date: 2025-09-05 DOI:10.1111/pan.70045

Kelly Moon, Sibelle Aurelie Yemele Kitio, Julie Rice-Weimer, Joseph D Tobias

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引用次数: 0

Abstract

Introduction: Endotracheal tube (ETT) cuff pressures that exceed 20-30 cmH₂O may lead to iatrogenic adverse effects such as cough, sore throat, and tracheal edema or more serious complications including tracheal stenosis, recurrent laryngeal nerve injury, and tracheal rupture. The current study evaluates a novel technique, titration of the ratio of expiratory to inspiratory tidal volumes (TV), to regulate intracuff pressure.

Methods: This prospective, cross-over trial measured intracuff pressure in a cohort of pediatric patients presenting for general anesthesia with an ETT. Intracuff pressure was measured following adjustment of the expiratory to inspiratory TV to various ratios (1.0, 0.9, and 0.8) by slow removal of air from the ETT cuff.

Results: The study cohort included 50 patients with a median age of 12 years. At baseline continuous positive airway pressure (CPAP), the median (IQR) intracuff pressure was 20.4 cmH₂O (13.6, 28.8). The intracuff pressure decreased to 12.2 cmH₂O (10.2, 18.4) at an expired tidal volume (TV_e) to inspired tidal volume (TV_i) ratio of 1, 8.9 cmH₂O (7.4, 10.9) at 0.9, and to 8.2 cmH₂O (6.8, 9.5) at a ratio of 0.8. With both the CPAP method and TVe/TVi ratio of 1, there were cuff pressures greater than 30 cmH₂O (10 with CPAP and 2 with TVe/TVi ratio of 1). With a TVe/TVi ratio of 0.9 or 0.8, there were no cuff pressures greater than 30 cmH₂O.

Conclusions: Adjustment of the TVe/TVi may be a more effective means of ensuring that the cuff pressure is in the desired range than other conventionally used clinical techniques such as sealing the airway to a CPAP of 20 cmH₂O.

Trial registration: ClinicalTrials.gov: NCT02768831.

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通过测量呼气与吸气潮气量之比来调节口内压力。

简介：气管内管（ETT）袖带压力超过20-30 cmH2O可能导致医源性不良反应，如咳嗽、喉咙痛、气管水肿或更严重的并发症，包括气管狭窄、喉返神经损伤和气管破裂。目前的研究评估了一种新的技术，呼气与吸气潮气量（TV）的比率滴定，以调节颅内压力。方法：这项前瞻性交叉试验测量了一组接受ETT全麻的儿科患者的眼内压。通过缓慢地从ETT袖带中去除空气，将呼气与吸气TV调整到不同的比率（1.0、0.9和0.8），测量口内压力。结果：研究队列包括50例患者，中位年龄为12岁。基线持续气道正压（CPAP）时，中位（IQR）颅内压为20.4 cmH2O（13.6, 28.8）。到期潮气量（TVe）与激发潮气量（TVi）之比为1时，槽内压力降至12.2 cmH2O(10.2, 18.4)， 0.9时降至8.9 cmH2O(7.4, 10.9)， 0.8时降至8.2 cmH2O（6.8, 9.5）。CPAP方法和TVe/TVi比值均为1时，袖带压力均大于30 cmH2O （CPAP为10，TVe/TVi比值为1时为2）。当TVe/TVi比值为0.9或0.8时，袖带压力不大于30 cmH2O。结论：调整TVe/TVi可能是一种更有效的方法，以确保袖带压力在所需的范围内，而不是其他常规使用的临床技术，如将气道封闭到20 cmH2O的CPAP。试验注册：ClinicalTrials.gov: NCT02768831。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.