Anesthesia Techniques and Monitors

Automated Cuff Pressure Modulation: A Novel Device to Reduce Endotracheal Tube Injury

Chadha NK, Gordin A, Luginbuehl I, et al (Hosp for Sick Children, Toronto, Ontario, Canada) Arch Otolaryngol Head Neck Surg 137:30-34, 2011^§

Abstract

Objective

To assess whether dynamically modulating endotracheal tube (ETT) cuff pressure, by decreasing it during each ventilatory cycle instead of maintaining a constant level, would reduce the extent of intubationrelated laryngotracheal injury.

Design

Single-blind, randomized controlled animal study using a previously validated live porcine model of accelerated intubation-related tracheal injury.

Setting

Animal research facility.

Patients

Ten piglets (weight, 16-20 kg each) were anesthetized and underwent intubation using a cuffed ETT.

Interventions

The animals were randomized into the following 2 groups: 5 pigs had a novel device to modulate their cuff pressure from 25 cm H₂O during inspiration to 7 cm H₂O during expiration, and 5 pigs had a constant cuff pressure of 25 cm H₂O. Both groups underwent ventilation under hypoxic conditions for 4 hours.

Main Outcome Measure

Laryngotracheal mucosal injury after blinded histopathological assessment.

Results

The modulated-pressure group showed significantly less overall laryngotracheal damage than the constant-pressure group (mean grades, 1.2 vs 2.1; P < .001). Subglottic damage and tracheal damage were significantly less severe in the modulated-pressure group (mean grades, 1.0 vs 2.2; P < .001, and 1.9 vs 3.2; P < .001, respectively). There was no significant difference in glottic or supraglottic damage between the groups (P = .06 and .27, respectively).

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