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Endotracheal Tube and Laryngeal Mask Airway Cuff Pressures Can Exceed Critical Values During Ascent to Higher Altitude.
MedLine Citation:
PMID:  21494168     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: Tracheal mucosal perfusion is compromised at an endotracheal tube (ETT) cuff pressure of 30 cm H2O, and blood flow is obstructed at a pressure of 50 cm H2O. METHODS:: We measured the change in pressure of air-filled cuffs of 6.0 and 7.5 ETTs and a size 4 laryngeal mask airway (LMA) from sea level to 2400 m. The ETTs and LMA cuff measurements were done with the devices uncontained, and an additional 6.0 ETT was placed in a 10-mL syringe barrel to mimic placement in a trachea. This restricted cuff expansion simulating what would occur when it is placed within the trachea. The pressure of fluid-filled 6.0 ETT cuffs was also measured. RESULTS:: Intracuff pressure increases linearly with increasing altitude, in all air-filled ETT and LMAs. Water-filled cuffs demonstrated no significant change in pressure with changes in altitude. The rate of ETT cuff pressure increase was greater for the ETT restricted within the syringe barrel compared with the unrestricted ETT cuff. The rate of LMA cuff pressure increase was greater than the rate of increase for all the ETTs (restricted and unrestricted). CONCLUSIONS:: This model indicates that ETT cuffs inflated before air transport are likely to exceed critical pressure levels rapidly during flight. In addition, there will be loss of ETT cuff pressure, with loss of a good seal, during descent if a cuff is initially inflated at peak altitudes. Therefore, we suggest ETT cuff pressures should be monitored and adjusted continuously during ascent and decent.
Authors:
Renee M Miyashiro; Loren G Yamamoto
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-13
Journal Detail:
Title:  Pediatric emergency care     Volume:  -     ISSN:  1535-1815     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507560     Medline TA:  Pediatr Emerg Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Emergency Department, Kapi'olani Medical Center for Women and Children, Honolulu, HI.
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