how much air to inflate endotracheal tube cuff

A. Secrest, B. R. Norwood, and R. Zachary, A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement, American Journal of Nurse Anesthestists, vol. The relationship between measured cuff pressure and volume of air in the cuff. Novel ETT cuffs made of polyurethane,158 silicone, 159 and latex 160 have been developed and . Underinflation increases the risk of air leakage and aspiration of gastric and oral pharyngeal secretions [4, 5]. W. N. Bernhard, L. Yost, D. Joynes, S. Cothalis, and H. Turndorf, Intracuff pressures in endotracheal and tracheostomy tubes. Students were under the supervision of a senior anesthetic officer or an anesthesiologist. Daniel I Sessler. This method is cheap and reproducible and is likely to estimate cuff pressures around the normal range. Listen for the presence of an air leak around the cuff during a positive pressure breath. It has been demonstrated that, beyond 50cmH2O, there is total obstruction to blood flow to the tracheal tissues. Google Scholar. Previous studies suggest that the cuff pressure is usually under-estimated by manual palpation. statement and Misting can be clearly seen to confirm intubation. demonstrate the presence of legionellae in aerosol droplets associated with suspected bacterial reservoirs. 2001, 137: 179-182. 70, no. In addition, acquired laryngeal stenosis may be caused by mechanical abrasion or pressure necrosis of the laryngeal mucosa secondary to high cuff pressure [13, 14]. Sengupta, P., Sessler, D.I., Maglinger, P. et al. 1, pp. 56, no. Zhonghua Yi Xue Za Zhi (Taipei). Note correct technique: While securing the ET tube with one hand, inflate the cuff with 5-10 cc's of air. These data suggest that tube size is not an important determinant of appropriate cuff inflation volume. It should however be noted that some of these studies have been carried out in different environments (emergency rooms) and on different kinds of patients (emergency patients) by providers of varying experience [2]. The cuff was then briefly overinflated through the pilot balloon, and the loss of resistance syringe plunger was allowed to passively draw back until it ceased. 1, p. 8, 2004. The datasets analyzed during the current study are available from the corresponding author on reasonable request. Cuff Pressure Measurement Check the cuff pressure after re-inflating the cuff and if there are any concerns for a leak. We conducted a single-blinded randomized control study to evaluate the LOR syringe method in accordance with the CONSORT guideline (CONSORT checklist provided as Supplementary Materials available here). We recommend the use of the cuff manometer whenever available and the LOR method as a viable option. 2013 Aug;117(2):428-34. doi: 10.1213/ANE.0b013e318292ee21. All these symptoms were of a new onset following extubation. Pelc P, Prigogine T, Bisschop P, Jortay A: Tracheoesophageal fistula: case report and review of literature. stroke. Upon closer inspection of the ETT that had been removed from the airway, there appeared to be a defect in which the air injected into the pilot balloon did not reach the cuff (see Figures 1 and 2). Air leaks are a common yet critical problem that require quick diagnosis. Box 7072, Kampala, Uganda (Email: rresearch9@gmail.com; research@chs.mak.ac.ug). ); and patients with known anatomical laryngeo-tracheal abnormalities were excluded from this study. This cookies is set by Youtube and is used to track the views of embedded videos. This has been shown to cause severe tracheal lesions and morbidity [7, 8]. El-Orbany M, Salem MR. Endotracheal tube cuff leaks: causes, consequences, and management. J. Rello, R. Soora, P. Jubert, A. Artigas, M. Ru, and J. Valls, Pneumonia in intubated patients: role of respiratory airway care, American Journal of Respiratory and Critical Care Medicine, vol. 30. In low- and middle-income countries, the cost of acquiring ($ 250300) and maintaining a cuff manometer is still prohibitive. One study, for instance, found that cuff pressure exceeded 40 cm H2O in 40-to-90% of tested patients [22]. Error in Inhaled Nitric Oxide Setup Results in No Delivery of iNO. The cuff was then briefly overinflated through the pilot balloon, and the loss of resistance syringe plunger was allowed to passively draw back until it ceased. The data collected including the number visitors, the source where they have come from, and the pages visited in an anonymous form. distance from the tip of the tube to the end of the cuff, which varies with tube size. Article Uncommon complication of Carlens tube. The rate of optimum endotracheal tube cuff pressure was 90.5% in the group guided by manometer and 31.8% in the conventional procedure group (p < 0.001 . This cookie is set by Google analytics and is used to store the traffic source or campaign through which the visitor reached your site. non-fasted patients, Size: 8mm diameter for men, 7mm diameter for women, Laryngoscope (check size the blade should reach between the lips and larynx size 3 for most patients), turn on light, Monitoring: end-tidal CO2 monitor, pulse oximeter, cardiac monitor, blood pressure, Medications in awake patient: hypnotic, analgesia, short-acting muscle relaxant (to aid intubation), Pre-oxygenate patient with high concentration oxygen for 3-5mins, Neck flexed to 15, head extended on neck (i.e. The intracuff pressure, volume of air needed to fill the cuff and seal the airway, number of tube changes required for a poor fit, number with intracuff pressure 20 cm H 2 O, and intracuff pressure 30 cm H 2 O are listed in Table 4. [22] observed cuff pressure exceeding 40 cm H2O in 91% of PACU patients after anesthesia with nitrous oxide, 55% of ICU patients, and 45% of PACU patients after anesthesia without nitrous oxide. The Human Studies Committee did not require consent from participating anesthesia providers. Secondly, this method is still provider-dependent as they decide when plunger drawback has ceased. This adds to the growing evidence to support the use of the LOR syringe for ETT cuff pressure estimation. Although we were unable to identify any statistically significant or clinically important differences among the sites or providers, our results apply only to the specific sites and providers we evaluated. Only 27% of pressures were within 2030 cmH2O; 27% exceeded 40 cmH2O. Routine checks of the ETT integrity and functionality before insertion used to be the standard of care, but the practice is becoming less common, although it is still recommended in current ASA guidelines.1. (Cuffed) endotracheal tubes seal the lower airway of at the cuff location in the trachea. BMC Anesthesiology However, post-intubation sore throat is a common side effect of general anesthetic and may partly result from ischemia of the oropharyngeal and tracheal mucosa [810], and the most common etiology of non-malignant tracheoesophageal fistula remains cuff-related tracheal injury [11, 12]. 1993, 104: 639-640. To obtain an adequate seal, it is recommended to inflate the cuff initially to a no-audible leak point at applied airway pressures of 20 cm H 2 O. There was no correlation between the measured cuff pressure and the age, sex, height, or weight of the patients. E. Resnikoff and A. J. Katz, A modified epidural syringe as an endotracheal tube cuff pressure-controlling device, Anaesthesia and Analgesia, vol. Lomholt et al. A total of 178 patients were enrolled from August 2014 to February 2015 with an equal distribution between arms as shown in the CONSORT diagram in Figure 1. 28, no. Airway 'protection' refers to preventing the lower airway, i.e. 1996-2023, The Anesthesia Patient Safety Foundation, APSF Patient Safety Priorities Advisory Groups, Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi, APSF Prevencin y Manejo de Fuegos Quirrgicos, APSF Prvention et gestion des incendies dans les blocs opratoires, Monitoring for Opioid-Induced Ventilatory Impairment (OIVI), Perioperative Visual Loss (POVL) Informed Consent, ASA/APSF Ellison C. Pierce, Jr., MD Memorial Lecturers, The APSF: Ten Patient Safety Issues Weve Learned from the COVID Pandemic, APSF Technology Education Initiative (TEI), Emergency Manuals Implementation Collaborative (EMIC), Perioperative Multi-Center Handoff Collaborative (MHC), APSF/FAER Mentored Research Training Grant, Investigator Initiated Research (IIR) Grants, Past APSF Consensus Conferences and Recommendations, Conflict in the Operating Room: Impact on Patient Safety Report from the ASA 2016 Annual Meetings APSF Workshop, Distractions in the Anesthesia Work Environment: Impact on Patient Safety. Remove the laryngoscope while holding the tube in place and remove the stylet from the tube. Crit Care Med. The ASA recommends checking all ETT cuffs prior to their use.1 While rare, endotracheal tube cuff defects are a known cause of endotracheal tube leaks which often necessitate endotracheal tube exchange. 23, no. Ann Chir. This study was not powered to evaluate associated factors, but there are suggestions that the levels of anesthesia providers with varying skill set and technique at direct laryngoscopy may be associated with a high incidence of complications. PubMed The pressure reading of the VBM was recorded by the research assistant. Decrease the cuff pressure to 30 cm H2O by withdrawing a small amount of air from the balloon with a 10 mL syringe. The tube will remain unstable until secured; therefore, it must be held firmly until then. Google Scholar. Similarly, inflation of endotracheal tube cuffs to 20 cm H2O for just four hours produces serious ciliary damage that persists for at least three days [16]. COPD, head injury, ARDS), Rapid sequence induction (RSI) intubation, Procedural variation using rapid anaesthetisation with cricoid pressure to prevent aspiration while airway is quickly secured, Used for patients at risk of aspiration e.g. However, less serious complications like dysphagia, hoarseness, and sore throat are more prevalent [911]. mental status changes, such as confusion . Compliance of the cuff system was evaluated by linear regression of measured cuff pressure vs. measured cuff volume. 2006;24(2):139143. These data suggest that management of cuff pressure was similar in these two disparate settings. chin anteriorly), no lateral deviation, Open mouth and inspect: remove any dentures/debris, suction any secretions, Holding laryngoscope in left hand, insert it looking down its length, Slide down right side of mouth until the tonsils are seen, Now move it to the left to push the tongue centrally until the uvula is seen, Advance over the base of the tongue until the epiglottis is seen, Apply traction to the long axis of the laryngoscope handle (this lifts the epiglottis so that the V-shaped glottis can be seen), Insert the tube in the groove of the laryngoscope so that the cuff passes the vocal cords, Remove laryngoscope and inflate the cuff of the tube with 15ml air from a 20ml syringe, Attach ventilation bag/machine and ventilate (~10 breaths/min) with high concentration oxygen and observe chest expansion and auscultate to confirm correct positioning, Consider applying CO2 detector or end-tidal CO2 monitor to confirm placement, if it takes more than 30 seconds, remove all equipment and ventilate patient with a bag and mask until ready to retry intubation. Advance the endotracheal tube through the vocal cords and into the trachea within 15 seconds. Cuff pressure adjustment: in both arms, very high and very low pressures were adjusted as per the recommendation by the ethics committee. Manage cookies/Do not sell my data we use in the preference centre. If the tracheal lumen is in the appropriate position (i.e., it has not been placed too deeply), bilateral breath sounds will. On the other hand, overinflation may cause catastrophic complications. Conclusion. The cookie is a session cookies and is deleted when all the browser windows are closed. 443447, 2003. You also have the option to opt-out of these cookies. When this point was reached, the 10ml syringe was then detached from the pilot balloon, and a cuff manometer (VBM, Medicintechnik Germany. Informed consent was sought from all participants. 2003, 38: 59-61. First, inflate the tracheal cuff and deflate the bronchial cuff. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat]. adequately inflate cuff . Retrieved from. Interestingly, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size (Table 3). Perioperative Handoffs: Achieving Consensus on How to Get it Right, APSF Website Offers Online Educational DVDs, APSF Announces the Procedure for Submitting Grant Applications, Request for Applications (RFA) for the Safety Scientist Career Development Award (SSCDA), http://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/statement-on-standard-practice-for-infection-prevention-for-tracheal-intubation.pdf. The patient was the only person blinded to the intervention group. Striebel HW, Pinkwart LU, Karavias T: [Tracheal rupture caused by overinflation of endotracheal tube cuff]. . Outcomes Research Institute, University of Louisville, 501 E. Broadway, Suite 210, Louisville, KY, 40202, USA, Papiya Sengupta,Daniel I Sessler&Anupama Wadhwa, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 S. Jackson St. University Hospital, Louisville, KY, 40202, USA, Daniel I Sessler,Paul Maglinger,Jaleel Durrani&Anupama Wadhwa, School of Medicine, University of Louisville School of Medicine, Louisville, KY, 40292, USA, You can also search for this author in In the control ETT, the cuff was inflated to 20 mm Hg to 22 mm Hg and not manipulated. Measured cuff volume averaged 4.4 1.8 ml. In our case, had the endotracheal tube been checked prior to the start of the case, the defect could have been easily identified which would have obviated the need for tube exchange. Aire cuffs are "mid-range" high volume, low pressure cuffs. Another viable argument is to employ a more pragmatic solution to prevent overly high cuff pressures by inflating the cuff until no air leak is detected by auscultation. Support breathing in certain illnesses, such . Heart Lung. The cookie is set by Google Analytics and is deleted when the user closes the browser. Intubation was atraumatic and the cuff was inflated with 10 ml of air. A research assistant (different from the anesthesia care provider) read out the patients group, and one of the following procedures was followed. 9, no. Article However you may visit Cookie Settings to provide a controlled consent. (States: would deflate the cuff, pull tube back slightly -1 cm, re-inflate the cuff, and auscultate for bilateral air entry). 8184, 2015. Consequences of micro-aspiration of oropharyngeal secretions include nosocomial pulmonary infections [1]. The initial, unadjusted cuff pressures from either method were used for this outcome. 10.1007/s001010050146. volume4, Articlenumber:8 (2004) 1984, 288: 965-968. ETT cuff pressures would be measured with a cuff manometer following estimation by either the PBP method or the LOR method. 1984, 24: 907-909. U. Nordin, The trachea and cuff-induced tracheal injury: an experimental study on causative factors and prevention, Acta Oto-Laryngologica, vol. We included ASA class I to III adult patients scheduled to receive general anesthesia with endotracheal intubation for elective surgical operation. Notes tube markers at front teeth, secures tube, and places oral airway. 111, no. The data were exported to and analyzed using STATA software version 12 (StataCorp Inc., Texas, USA). Air Leak in a Pediatric CaseDont Forget to Check the Mask! 2001, 55: 273-278. We measured the tracheal cuff pressures at ground level and at 3000 ft, in 10 intubated patients. All authors read and approved the final manuscript. This cookie is set by Stripe payment gateway. K. C. Park, Y. D. Sohn, and H. C. Ahn, Effectiveness, preference and ease of passive release techniques using a syringe for endotracheal tube cuff inflation, Journal of the Korean Society of Emergency Medicine, vol. Outcomes were compared by tube size, provider, and hospital with either an ANOVA (if the values were normally distributed) or the Kruskal-Wallis statistic (if the values were skewed). [21] found that the volume of air required to inflate the endotracheal tube cuff varies as a function of tube size and type. Statement on the Standard Practice for Infection Prevention and Control Instruments for Tracheal Intubation. Christina M. Brown, MD, Resident, Department of Anesthesiology, Washington University in St. Louis, MO. All tubes had high-volume, low-pressure cuffs. Neither measured cuff pressure nor measured cuff volume differed among the hospitals (Table 2). This is an open access article distributed under the, PBP group (active comparator): in this group, the anesthesia care provider was asked to reduce or increase the pressure in the ETT cuff by inflating with air or deflating the pilot balloon using a 10ml syringe (BD Discardit II) while simultaneously palpating the pilot balloon until a point he or she felt was appropriate for the patient. 208211, 1990. This point was observed by the research assistant and witnessed by the anesthesia care provider. This result suggests that clinicians are now making reasonable efforts to avoid grossly excessive cuff inflation. If using a neonatal or pediatric trach, draw 5 ml air into syringe. Article 1981, 10: 686-690. If more than 5 ml of air is necessary to inflate the cuff, this is an . Most manometers are calibrated in? Our results thus fail to support the theory that increased training improves cuff management. 2016 National Geriatric Surgical Initiatives, 2017 EC Pierce Lecture: Safety Beyond Our Borders, The Anesthesia Professionals Role in Patient Safety During TAVR (Transcatheter Aortic Valve Replacement). The end of the cuff must not impinge the opening of the Murphy eye; it must not herniate over the tube tip under normal conditions; and the cuff must inflate symmetrically around the ETT.1 All cuffs are part of a cuff system consisting of the cuff itself plus . 14231426, 1990. Alternatively, cheaper, reproducible methods, like the minimum leak test that limit overly high cuff pressures should be sought and evaluated. In an experimental study, Fernandez et al. Because nitrous oxide was not used, it is unlikely that the cuff pressures varied much during the first hour of the study cases. Br Med J (Clin Res Ed). Google Scholar. However, the presence of contradictory findings (tense cuff bulb, holding appropriate inflating pressure in the presence of a major air leak) confounded the diagnostic process, while a preoperative check of the ETT would have unequivocally detected the defect in the cuff tube. 10.1007/s00134-003-1933-6. Approved by the ASA House of Delegates on October 20, 2010, and last amended on October 28, 2015. 18, no. 5, pp. Cuff pressure reading of the VBM manometer was recorded by the research assistant. The cookie is used to determine new sessions/visits. Patients with emergency intubations, difficult intubations, or intubation performed by non-anesthesiology staff; pregnant women; patients with higher risk for aspiration (e.g., full stomach, history of reflux, etc. Animal data indicate that a cuff pressure of only 20 cm H2O may significantly reduce tracheal blood flow with normal blood pressure and critically reduces it during severe hypotension [15]. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. Anaesthesist. In the early years of training, all trainees provide anesthesia under direct supervision. Anaesthesist. The entire process required about a minute. Ninety-three patients were randomly assigned to the study. The Data Safety Management Board (DSMB) comprised an anesthesiologist, a statistician, and a member of the SOMREC IRB who would be informed of any adverse event. Fernandez et al. Although the ETT pilot balloon was noted to be appropriately tense to the touch, a small amount of air was added to the cuff. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. In case of a very low pressure reading (below 20cmH, https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. But opting out of some of these cookies may have an effect on your browsing experience. Reduces risk of creasing on inflation and minimises pressure on tracheal wall. SuperWes explains how to know the difference.Thx to Caleb@BDM Films for the FX In the absence of clear guidelines, many clinicians consider 20 cm H2O a reasonable lower limit for cuff pressure in adults. If the patient is able to talk, the cuff is not inflated adequately (air is vibrating the vocal cords). 7 It has been shown that the best way to ensure adequate sealing and avoid underinflation (or overinflation) is to monitor the intracuff pressure periodically and maintain the intracuff pressure within Inflation of the cuff of . Also to note, most cuffs in the PBP group were inflated to a pressure that exceeded the recommended range in the PBP group, and 51% of the cuff pressures attained had to be adjusted compared with only 12% in the LOR group (Table 2). muscle or joint pains. Continuous data are presented as the mean with standard deviation and were compared between the groups using the t-test to detect any significant statistical differences. Generally, the proportion of ETT cuffs inflated to the recommended pressure was less in the PBP group at 22.5% (20/89) compared with the LOR group at 66.3% (59/89) with a statistically significant positive mean difference of 0.47 with value<0.01 (0.3430.602). APSF President Robert K. Stoelting, MD: A Tribute to 19 Years of Steadfast Leadership, Immediate Past Presidents Report Highlights Accomplishments of 2016, Save the Date! Using a laryngoscope, tracheal intubation was performed, ETT position confirmed, and secured with tape within 2min. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Circulation 122,210 Volume 31, No. Privacy Standard cuff pressure is 25mmH20 measured with a manometer. laryngeal mask airway [LMA], i-Gel), How to insert a nasopharyngeal airway (NPA), Common hypertensive emergencyexam questions for medical finals, OSCEs and MRCP PACES, Guedel Airway Insertion Initial Assessment of a Trauma Patient, Haemoptysis case study with questions and answers, A fexible plastic tube with cuff on end which sits inside the trachea (fully secures airway the gold standard of airway management), Ventilation during anaesthetic for surgery (if muscle relaxant is required, long case, abdominal surgery, or head positing may be required), Patient cant protect their airway (e.g. Charles Kojjo, Agnes Wabule, and Nodreen Ayupo were responsible for patient recruitment and data collection and analysis. S. Stewart, J. The cookie is not used by ga.js. PubMedGoogle Scholar. The integrity of the entire breathing circuit and correct positioning of the ETT between the vocal cords with direct laryngoscopy were confirmed. Interestingly, there was also no significant or important difference as a function of provider measured cuff pressures were virtually identical whether filled by CRNAs, residents, or attending anesthesiologists. It was nonetheless encouraging that we observed relatively few extremely high values, at least many fewer than reported in previous studies [22]. 71, no. Blue radio-opaque line. Provided by the Springer Nature SharedIt content-sharing initiative. On the other hand, Nordin et al. P. Sengupta, D. I. Sessler, P. Maglinger et al., Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, BMC Anesthesiology, vol. The study groups were similar in relation to sex, age, and ETT size (Table 1). Acta Anaesthesiol Scand. This cookie is installed by Google Analytics. We therefore also evaluated cuff pressure during anesthesia provided by certified registered nurse anesthetists (CRNAs), anesthesia residents, and anesthesia faculty. We recognize that people other than the anesthesia provider who actually conducted the case often inflated the cuffs. (Supplementary Materials). Our study set out to investigate the efficacy of the loss of resistance syringe in a surgical population under general anesthesia. Measured cuff pressures averaged 35.3(21.6)cmH2O; only 27% of the patients had measured pressures within the recommended range of 2030 cmH2O. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. An initial intracuff pressure of 30 cmH2O decreased to 20 cmH2O at 7 to 9 hours after inflation. The hospital has a bed capacity of 1500 inpatient beds, 16 operating rooms, and a mean daily output of 90 surgical operations. With the patients head in a neutral position, the anesthesia care provider inflated the ETT cuff with air using a 10ml syringe (BD Discardit II). The difference in the number of intubations performed by the different level of providers is huge with anesthesia residents and anesthetic officers performing almost all intubation and initial cuff pressure estimations. The cuff is inflated with air via a one-way valve attached to the cuff through a separate tube that runs the length of the endotracheal tube. The study was approved by Makerere University College of Health Sciences, School of Medicine Research Ethics Committee (SOMREC), The Secretariat Makerere University College of Health Sciences, Clinical Research Building, Research Co-ordination Office, P.O. 33. - Manometer - 3- way stopcock. This cookie is native to PHP applications. Bouvier JR: Measuring tracheal tube cuff pressures--tool and technique. The poster can be accessed by following the link: https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. How do you measure cuff pressure? Consecutive available patients were enrolled until we had recruited at least 10 patients for each endotracheal tube size at each participating hospital. The cookies store information anonymously and assign a randomly generated number to identify unique visitors. Luna CM, Legarreta G, Esteva H, Laffaire E, Jolly EC: Effect of tracheal dilatation and rupture on mechanical ventilation using a low-pressure cuff tube. N. Lomholt, A device for measuring the lateral wall cuff pressure of endotracheal tubes, Acta Anaesthesiologica Scandinavica, vol. By clicking Accept, you consent to the use of all cookies. The regression equation indicated that injected volumes between 2 and 4 ml usually produce cuff pressures between 20 and 30 cmH2O independent of tube size for the same type of tube. The groups were not equal for the three different types of practitioners; however, determining differences of practice between different anesthesia providers was not the primary purpose of our study. R. D. Seegobin and G. L. van Hasselt, Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs, British Medical Journal, vol. 1: anesthesia resident; 2: anesthesia officer; 3: anesthesia officer student; 4: anesthesiologist. Crit Care Med. Taking another approach to the same question, we also determined compliance of the cuff-trachea system in vivo by plotting measured cuff pressure against cuff volume. The study comprised more female patients (76.4%). Figure 2. 32. Cite this article. 3 87, no. 2023 BioMed Central Ltd unless otherwise stated. Acta Anaesthesiol Scand. Use low cuff pressures and choosing correct size tube. In certain instances, however, it can be used to. After induction of anesthesia, a 71-year-old female patient undergoing a parotidectomy was nasally intubated with a TaperGuard 6.5 Nasal RAE tube using a C-MAC KARL STORZ GmbH & Co. KG Mittelstrae 8, 78532 Tuttlingen, Germany, video-laryngoscope. Figure 2. Correspondence to Cuff pressure adjustment: in both arms, very high and very low pressures were adjusted as per the recommendation by the ethics committee. Compared with the cuff manometer, it would be cheaper to acquire and maintain a loss of resistance syringe especially in low-resource settings. Bunegin L, Albin MS, Smith RB: Canine tracheal blood flow after endotracheal tube cuff inflation during normotension and hypotension. On the other hand, high cuff pressures beyond 50cmH2O were reduced to 40cmH2O. The cookie is used to identify individual clients behind a shared IP address and apply security settings on a per-client basis. With approval of the University of Louisville Human Studies Committee and informed consent, we recruited 93 patients (42 men and 51 women) undergoing elective surgery with general endotracheal anesthesia from three hospitals in Louisville, Kentucky: 41 patients from University Hospital (an academic centre), 32 from Jewish Hospital (a private hospital), and 20 from Norton Hospital (also a private hospital). Copyright 2013-2023 Oxford Medical Education Ltd. Myasthenia Gravis (MG) Neurological Examination, Questions about DVT (Deep Vein Thrombosis), Endotracheal tube (ETT) insertion (intubation), Supraglottic airway (e.g. The author(s) declare that they have no competing interests. Nor did measured cuff pressure differ as a function of endotracheal tube size. February 2017

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