Effect of Transesophageal Echocardiography Probe Insertion on Endotracheal Tube Cuff Pressure in Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery. A Prospective Randomized Control Trial.

Introduction: Elevated endotracheal tube (ETT) cuff pressures during surgery can lead to tracheal ischemia and airway complications, including postoperative sore throat, subglottic edema, and tracheal stenosis. The insertion of a transesophageal echocardiography (TEE) probe, commonly used in cardiac surgeries, may increase ETT cuff pressure due to its proximity to the trachea. This study assesses the impact of TEE probe insertion on ETT cuff pressures and related postoperative airway complications in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: In this prospective, randomized controlled trial, 40 patients undergoing CABG were assigned to either a control group (Group C, n = 20) or an intervention group (Group T, n = 20). Cuff pressures were monitored at baseline (T1), during TEE probe manipulation (T2), after initial examination (T3), and during recovery (T4). In Group T, cuff pressures were adjusted to 20-30 cmH2O if they exceeded 30 cmH2O during T2 and T3. Postoperative complications, including sore throat, hoarseness, and cough, were assessed using standardized scales.

Results: TEE probe manipulation significantly increased ETT cuff pressures in both groups, with lower pressures consistently observed in Group T (P < 0.05). At T3, the mean cuff pressure in Group C was 41.00 cmH2O versus 33.30 cmH2O in Group T (P < 0.001). The control group experienced more severe postoperative airway complications, while Group T had a significantly reduced risk of severe complications (odds ratio < 0.2).

Conclusion: TEE probe manipulation significantly increases ETT cuff pressures, but cuff deflation during manipulation effectively reduces these pressures and lowers the risk of postoperative airway complications.