Document Detail

Do lower cuff pressures reduce damage to the tracheal mucosa? A scanning electron microscopy study in neonatal pigs.
MedLine Citation:
PMID:  23137044     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Modern high volume-low pressure (HVLP) endotracheal tubes (ETT) cuffs can seal the trachea using baseline cuff pressures (CP) lower than peak inspiratory airway pressures (PIP). The aim of the study was to determine whether this technique reduces the damage to the tracheal mucosa compared to constant CP of 20 cmH(2)O.
METHODS: Eighteen piglets were intubated with an ID 4.0 mm HVLP cuffed ETT (Microcuff PET) and artificially ventilated with 20 cmH(2)O PIP and 5 cmH(2)O PEEP. Animals were randomly allocated to two groups of CP: group A (just seal; n = 9) and group B (20 cmH(2)O; n = 9), controlled constantly with a manometer during the following 4-h study period under sevoflurane anesthesia. After euthanasia, cuff position was marked in situ. Damage in the cuff region was evaluated with scanning electron microscopy (SEM) examination by grading of mucosal damage and by estimating percentage of intact mucosal area both by a blinded observer.
RESULTS: Maximal CP to seal the trachea in group A ranged from 12 to 18 cmH(2)O (median: 14 cmH(2)O). Using a mixed effects model approach, the estimated mean effect of group B vs group A was an increase of 17.9% (SE 8.1%) higher proportion of pictures with an area of at least 5% intact mucosa (P = 0.042).
CONCLUSION: Minimal sealing pressures with cyclic pressure changes from CP did not result in decreased damage to the tracheal mucosa compared to constant CP of 20 cmH(2)O in this short-term animal trial.
Annette P N Kutter; Anne G Bittermann; Regula Bettschart-Wolfensberger; Nelly Spielmann; Sonja Hartnack; Urs Ziegler; Markus Weiss; Jacqueline Y Mauch
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Publication Detail:
Type:  Journal Article     Date:  2012-11-09
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  23     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-07     Completed Date:  2013-06-17     Revised Date:  2014-08-29    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  117-21     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
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MeSH Terms
Air Pressure
Anesthesia, Inhalation
Anesthetics, Inhalation
Animals, Newborn
Cilia / pathology,  ultrastructure
Intubation, Intratracheal / adverse effects*
Linear Models
Methyl Ethers
Microscopy, Electron, Scanning
Mucous Membrane / injuries*,  pathology*
Respiration, Artificial
Trachea / injuries*,  pathology*
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Methyl Ethers; 28523-86-6/sevoflurane
Comment In:
Paediatr Anaesth. 2014 Aug;24(8):883-5   [PMID:  25039874 ]
Paediatr Anaesth. 2014 Aug;24(8):885-6   [PMID:  25039875 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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