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Respir Care. 2019 Jul 30. pii: respcare.06728. doi: 10.4187/respcare.06728. [Epub ahead of print]

Laboratory Evaluation of Cuff Pressure Control Methods.

Author information

1
Cleveland Clinic, Respiratory Therapy Institute, Cleveland, Ohio. babics@ccf.org.
2
Cleveland Clinic, Respiratory Therapy Institute, Cleveland, Ohio.

Abstract

BACKGROUND:

Automatic cuff pressure (Pcuff) control devices for artificial airways are available, yet there are no standards or data to support their use. We hypothesized that airway pressure oscillations during mechanical ventilation are transmitted to Pcuff; and that the change in mean Pcuff (ΔPcuff) is zero during mechanical ventilation with controlled or uncontrolled Pcuff.

METHODS:

Experiments lasted 12 h, and 2 inspiratory pressure targets (Pinsp) were established. We tested 3 automatic devices (Intellicuff Standalone, PressureEyes, and Tracoe) and one manual method for uncontrolled Pcuff. We utilized a training mannequin with an 8-mm endotracheal tube to assess pressure-controlled continuous mechanical ventilation with the following parameters: breathing frequency = 20 breaths/min, TI = 1.0 s, PEEP = 10 cm H2O, and Pinsp = 10 and 40 cm H2O. For automatic cuff pressure control, we used a data acquisition system. For manual cuff pressure control, Pcuff was set once and measured after mechanical ventilation. Initial Pcuff was 25 cm H2O, and ΔPcuff was calculated as final mean Pcuff - initial mean Pcuff. Data for ΔPcuff were compared with t tests and reported as mean (SD).

RESULTS:

Airway pressure oscillations during ventilation were observed in Pcuff waveforms. For manual control, ΔPcuff was -9.3 (2.1) cm H2O for Pinsp = 10 cm H2O and -8.1 (1.1) cm H2O for Pinsp = 40 cm H2O (vs 0, P < .001). There was no difference in ΔPcuff for Pinsp = 10 cm H2O versus 40 cm H2O (P = .21). ΔPcuff was only ± 0.3 cm H2O for automatic control, which we deemed clinically unimportant.).

CONCLUSION:

Automatic devices do not regulate ventilatory pressure oscillations, but they do control mean Pcuff and keep ΔPcuff well below a clinically important threshold. The large ΔPcuff seen with uncontrolled Pcuff warrants periodic monitoring. Further studies are needed to determine the source of ΔPcuff and the physiologic effects of Pcuff oscillations during mechanical ventilation.

KEYWORDS:

airway management; cuff pressure regulators; endotracheal tube; mechanical ventilation

PMID:
31363001
DOI:
10.4187/respcare.06728

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