Skip to main content
Top
Published in: Journal of Clinical Monitoring and Computing 1/2012

01-02-2012

Endotracheal tube cuff-small important part of a big issue

Authors: Shai Efrati, Israel Deutsch, Gabriel M. Gurman

Published in: Journal of Clinical Monitoring and Computing | Issue 1/2012

Login to get access

Abstract

Many of the complications related to prolonged ventilation are related to inappropriate handling of endotracheal tube (ETT) cuff. This article reviews the possible complications associated with the ETT cuff, and the landmark development made in that field. The article challenges the present paradigm of cuff use and reviews the current clinical practice in that area.
Literature
1.
go back to reference Efrati S, Deutsch I, Antonelli M, Hockey PM, Rozenblum R, Gurman GM. Ventilator-associated pneumonia: current status and future recommendations. J Clin Monit Comput. 2010;24:161–8.PubMedCrossRef Efrati S, Deutsch I, Antonelli M, Hockey PM, Rozenblum R, Gurman GM. Ventilator-associated pneumonia: current status and future recommendations. J Clin Monit Comput. 2010;24:161–8.PubMedCrossRef
2.
go back to reference Ferdinande P, Kim DO. Prevention of postintubation laryngotracheal stenosis. Acta Otorhinolaryngol Belg. 1995;49:341–6.PubMed Ferdinande P, Kim DO. Prevention of postintubation laryngotracheal stenosis. Acta Otorhinolaryngol Belg. 1995;49:341–6.PubMed
3.
go back to reference Klainer AS, Turndorf H, Wu WH, Maewal H, Allender P. Surface alterations due to endotracheal intubation. Am J Med. 1975;58:674–83.PubMedCrossRef Klainer AS, Turndorf H, Wu WH, Maewal H, Allender P. Surface alterations due to endotracheal intubation. Am J Med. 1975;58:674–83.PubMedCrossRef
4.
go back to reference Lewis FR Jr, Schiobohm RM, Thomas AN. Prevention of complications from prolonged tracheal intubation. Am J Surg. 1978;135:452–7.PubMedCrossRef Lewis FR Jr, Schiobohm RM, Thomas AN. Prevention of complications from prolonged tracheal intubation. Am J Surg. 1978;135:452–7.PubMedCrossRef
5.
go back to reference Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70:65–76.PubMedCrossRef Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70:65–76.PubMedCrossRef
6.
go back to reference Podwinska E, Josko J, Kucewicz-Czech E, Misiolek H, Klimasara J, Szozda M. Pioneers of anaesthesiology—Arthur Ernest Guedel (1883–1956). Anestezjologia intensywna terapia. 2008;40:192–4.PubMed Podwinska E, Josko J, Kucewicz-Czech E, Misiolek H, Klimasara J, Szozda M. Pioneers of anaesthesiology—Arthur Ernest Guedel (1883–1956). Anestezjologia intensywna terapia. 2008;40:192–4.PubMed
7.
go back to reference SH C. Two men and their dog: Ralph Waters, Arthur Guedel and the dunked dog, “Airway”. Park Ridge, IL: Wood Library Museum; 2004. SH C. Two men and their dog: Ralph Waters, Arthur Guedel and the dunked dog, “Airway”. Park Ridge, IL: Wood Library Museum; 2004.
8.
go back to reference Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3, 423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114:42–8.PubMedCrossRef Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3, 423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114:42–8.PubMedCrossRef
9.
go back to reference Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161:1450–8.PubMed Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161:1450–8.PubMed
10.
go back to reference Gray P, Sullivan G, Ostryzniuk P, McEwen TA, Rigby M, Roberts DE. Value of postprocedural chest radiographs in the adult intensive care unit. Crit Care Med. 1992;20:1513–8.PubMedCrossRef Gray P, Sullivan G, Ostryzniuk P, McEwen TA, Rigby M, Roberts DE. Value of postprocedural chest radiographs in the adult intensive care unit. Crit Care Med. 1992;20:1513–8.PubMedCrossRef
11.
go back to reference American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005;112:IV1–203. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005;112:IV1–203.
12.
go back to reference Hartrey R, Kestin IG. Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. Anaesthesia. 1995;50:682–7.PubMedCrossRef Hartrey R, Kestin IG. Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. Anaesthesia. 1995;50:682–7.PubMedCrossRef
13.
go back to reference Krivopal M, Shlobin OA, Schwartzstein RM. Utility of daily routine portable chest radiographs in mechanically ventilated patients in the medical ICU. Chest. 2003;123:1607–14.PubMedCrossRef Krivopal M, Shlobin OA, Schwartzstein RM. Utility of daily routine portable chest radiographs in mechanically ventilated patients in the medical ICU. Chest. 2003;123:1607–14.PubMedCrossRef
14.
go back to reference Hejblum G, Chalumeau-Lemoine L, Ioos V, Boelle PY, Salomon L, Simon T, Vibert JF, Guidet B. Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet. 2009;374:1687–93.PubMedCrossRef Hejblum G, Chalumeau-Lemoine L, Ioos V, Boelle PY, Salomon L, Simon T, Vibert JF, Guidet B. Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet. 2009;374:1687–93.PubMedCrossRef
15.
go back to reference Olufolabi AJ, Charlton GA, Spargo PM. Effect of head posture on tracheal tube position in children. Anaesthesia. 2004;59:1069–72.PubMedCrossRef Olufolabi AJ, Charlton GA, Spargo PM. Effect of head posture on tracheal tube position in children. Anaesthesia. 2004;59:1069–72.PubMedCrossRef
16.
17.
go back to reference Petring OU, Adelhoj B, Jensen BN, Pedersen NO, Lomholt N. Prevention of silent aspiration due to leaks around cuffs of endotracheal tubes. Anesth Analg. 1986;65:777–80.PubMedCrossRef Petring OU, Adelhoj B, Jensen BN, Pedersen NO, Lomholt N. Prevention of silent aspiration due to leaks around cuffs of endotracheal tubes. Anesth Analg. 1986;65:777–80.PubMedCrossRef
18.
go back to reference Young PJ, Basson C, Hamilton D, Ridley SA. Prevention of tracheal aspiration using the pressure-limited tracheal tube cuff. Anaesthesia. 1999;54:559–63.PubMedCrossRef Young PJ, Basson C, Hamilton D, Ridley SA. Prevention of tracheal aspiration using the pressure-limited tracheal tube cuff. Anaesthesia. 1999;54:559–63.PubMedCrossRef
19.
go back to reference Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176:1079–83.PubMedCrossRef Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176:1079–83.PubMedCrossRef
20.
go back to reference Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care Med. 1993;21:518–21.PubMedCrossRef Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care Med. 1993;21:518–21.PubMedCrossRef
21.
go back to reference Asai T, Shingu K. Leakage of fluid around high-volume, low-pressure cuffs apparatus A comparison of four tracheal tubes. Anaesthesia. 2001;56:38–42.PubMedCrossRef Asai T, Shingu K. Leakage of fluid around high-volume, low-pressure cuffs apparatus A comparison of four tracheal tubes. Anaesthesia. 2001;56:38–42.PubMedCrossRef
22.
go back to reference Young PJ, Ridley SA, Downward G. Evaluation of a new design of tracheal tube cuff to prevent leakage of fluid to the lungs. Br J Anaesth. 1998;80:796–9.PubMed Young PJ, Ridley SA, Downward G. Evaluation of a new design of tracheal tube cuff to prevent leakage of fluid to the lungs. Br J Anaesth. 1998;80:796–9.PubMed
23.
go back to reference Young PJ, Rollinson M, Downward G, Henderson S. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997;78:557–62.PubMed Young PJ, Rollinson M, Downward G, Henderson S. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997;78:557–62.PubMed
24.
go back to reference Oikkonen M, Aromaa U. Leakage of fluid around low-pressure tracheal tube cuffs. Anaesthesia. 1997;52:567–9.PubMedCrossRef Oikkonen M, Aromaa U. Leakage of fluid around low-pressure tracheal tube cuffs. Anaesthesia. 1997;52:567–9.PubMedCrossRef
25.
go back to reference Blunt MC, Young PJ, Patil A, Haddock A. Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration. Anesthesiology. 2001;95:377–81.PubMedCrossRef Blunt MC, Young PJ, Patil A, Haddock A. Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration. Anesthesiology. 2001;95:377–81.PubMedCrossRef
26.
go back to reference Reali-Forster C, Kolobow T, Giacomini M, Hayashi T, Horiba K, Ferrans VJ. New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep. Anesthesiology 1996;84:162–172 (discussion 127A). Reali-Forster C, Kolobow T, Giacomini M, Hayashi T, Horiba K, Ferrans VJ. New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep. Anesthesiology 1996;84:162–172 (discussion 127A).
27.
go back to reference Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med. 2003;29:1849–53.PubMedCrossRef Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. Intensive Care Med. 2003;29:1849–53.PubMedCrossRef
28.
go back to reference Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC. A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care. 2011;26:280–6.PubMedCrossRef Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC. A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care. 2011;26:280–6.PubMedCrossRef
29.
go back to reference Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovas Surg. 2008;135:771–6.CrossRef Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovas Surg. 2008;135:771–6.CrossRef
30.
go back to reference Karasawa F, Matsuoka N, Kodama M, Okuda T, Mori T, Kawatani Y. Repeated deflation of a gas-barrier cuff to stabilize cuff pressure during nitrous oxide anesthesia. Anesth Analg 2002;95:243–248 (table of contents). Karasawa F, Matsuoka N, Kodama M, Okuda T, Mori T, Kawatani Y. Repeated deflation of a gas-barrier cuff to stabilize cuff pressure during nitrous oxide anesthesia. Anesth Analg 2002;95:243–248 (table of contents).
31.
go back to reference Tu HN, Saidi N, Leiutaud T, Bensaid S, Menival V, Duvaldestin P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187–90.PubMed Tu HN, Saidi N, Leiutaud T, Bensaid S, Menival V, Duvaldestin P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg. 1999;89:187–90.PubMed
32.
go back to reference Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery—manual vs. automatic method. J Anaesthesiol Clin Pharmacol. 2011;27:358–61.PubMedCrossRef Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery—manual vs. automatic method. J Anaesthesiol Clin Pharmacol. 2011;27:358–61.PubMedCrossRef
33.
go back to reference Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M. Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth. 2010;105:538–43.PubMedCrossRef Dave MH, Frotzler A, Spielmann N, Madjdpour C, Weiss M. Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br J Anaesth. 2010;105:538–43.PubMedCrossRef
34.
go back to reference Zanella A, Scaravilli V, Isgro S, Milan M, Cressoni M, Patroniti N, Fumagalli R, Pesenti A. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med. 2011;37:343–7.PubMedCrossRef Zanella A, Scaravilli V, Isgro S, Milan M, Cressoni M, Patroniti N, Fumagalli R, Pesenti A. Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study. Intensive Care Med. 2011;37:343–7.PubMedCrossRef
35.
go back to reference Zanella A, Cressoni M, Epp M, Stylianou M, Kolobow T. A double-layer tracheal tube cuff designed to prevent leakage: a bench-top study. Intensive Care Med. 2008;34:1145–9.PubMedCrossRef Zanella A, Cressoni M, Epp M, Stylianou M, Kolobow T. A double-layer tracheal tube cuff designed to prevent leakage: a bench-top study. Intensive Care Med. 2008;34:1145–9.PubMedCrossRef
36.
go back to reference American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Critic Care Med 2005:171:388–416. American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Critic Care Med 2005:171:388–416.
37.
go back to reference Chastre J, Fagon JY, Soler P, Bornet M, Domart Y, Trouillet JL, Gibert C, Hance AJ. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med. 1988;85:499–506.PubMedCrossRef Chastre J, Fagon JY, Soler P, Bornet M, Domart Y, Trouillet JL, Gibert C, Hance AJ. Diagnosis of nosocomial bacterial pneumonia in intubated patients undergoing ventilation: comparison of the usefulness of bronchoalveolar lavage and the protected specimen brush. Am J Med. 1988;85:499–506.PubMedCrossRef
38.
go back to reference Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122:2115–21.PubMedCrossRef Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122:2115–21.PubMedCrossRef
39.
go back to reference Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med. 2009;35:9–29.PubMedCrossRef Torres A, Ewig S, Lode H, Carlet J. Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med. 2009;35:9–29.PubMedCrossRef
40.
go back to reference Estes RJ, Meduri GU. The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med. 1995;21:365–83.PubMedCrossRef Estes RJ, Meduri GU. The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med. 1995;21:365–83.PubMedCrossRef
41.
go back to reference Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Resp Care 2005;50:725–39 (discussion 739–741). Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Resp Care 2005;50:725–39 (discussion 739–741).
42.
go back to reference Alcon A, Fabregas N, Torres A. Hospital-acquired pneumonia: etiologic considerations. Infect Dis Clin North Am. 2003;17:679–95.PubMedCrossRef Alcon A, Fabregas N, Torres A. Hospital-acquired pneumonia: etiologic considerations. Infect Dis Clin North Am. 2003;17:679–95.PubMedCrossRef
43.
go back to reference Bone DK, Davis JL, Zuidema GD, Cameron JL. Aspiration pneumonia. Prevention of aspiration in patients with tracheostomies. Ann Thoraci Surg. 1974;18:30–7.CrossRef Bone DK, Davis JL, Zuidema GD, Cameron JL. Aspiration pneumonia. Prevention of aspiration in patients with tracheostomies. Ann Thoraci Surg. 1974;18:30–7.CrossRef
44.
go back to reference Gal TJ. Effects of endotracheal intubation on normal cough performance. Anesthesiology. 1980;52:324–9.PubMedCrossRef Gal TJ. Effects of endotracheal intubation on normal cough performance. Anesthesiology. 1980;52:324–9.PubMedCrossRef
45.
go back to reference Levine SA, Niederman MS. The impact of tracheal intubation on host defenses and risks for nosocomial pneumonia. Clin Chest Med. 1991;12:523–43.PubMed Levine SA, Niederman MS. The impact of tracheal intubation on host defenses and risks for nosocomial pneumonia. Clin Chest Med. 1991;12:523–43.PubMed
46.
go back to reference Dave MH, Frotzler A, Weiss M. Closed tracheal suction and fluid aspiration past the tracheal tube. Impact of tube cuff and airway pressure. Minerva anestesiologica. 2011;77:166–71.PubMed Dave MH, Frotzler A, Weiss M. Closed tracheal suction and fluid aspiration past the tracheal tube. Impact of tube cuff and airway pressure. Minerva anestesiologica. 2011;77:166–71.PubMed
47.
go back to reference Dave MH, Frotzler A, Madjdpour C, Koepfer N, Weiss M. Massive aspiration past the tracheal tube cuff caused by closed trachael suction system. J Intens Care Med. 2011;26:326–9. Dave MH, Frotzler A, Madjdpour C, Koepfer N, Weiss M. Massive aspiration past the tracheal tube cuff caused by closed trachael suction system. J Intens Care Med. 2011;26:326–9.
48.
go back to reference Dave MH, Koepfer N, Madjdpour C, Frotzler A, Weiss M. Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication. J Anesth. 2010;24:247–52.PubMedCrossRef Dave MH, Koepfer N, Madjdpour C, Frotzler A, Weiss M. Tracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication. J Anesth. 2010;24:247–52.PubMedCrossRef
49.
go back to reference Berra L, Panigada M, De Marchi L, Greco G, Yu ZX, Baccarelli A, Pohlmann J, Costello KF, Appleton J, Mahar R, et al. New approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health. Minerva anestesiologica. 2003;69:342–7.PubMed Berra L, Panigada M, De Marchi L, Greco G, Yu ZX, Baccarelli A, Pohlmann J, Costello KF, Appleton J, Mahar R, et al. New approaches for the prevention of airway infection in ventilated patients. Lessons learned from laboratory animal studies at the National Institutes of Health. Minerva anestesiologica. 2003;69:342–7.PubMed
50.
go back to reference Efrati S, Leonov Y, Oron A, Siman-Tov Y, Averbukh M, Lavrushevich A, Golik A. Optimization of endotracheal tube cuff filling by continuous upper airway carbon dioxide monitoring. Anesth Analg 2005;101:1081–1088 (table of contents). Efrati S, Leonov Y, Oron A, Siman-Tov Y, Averbukh M, Lavrushevich A, Golik A. Optimization of endotracheal tube cuff filling by continuous upper airway carbon dioxide monitoring. Anesth Analg 2005;101:1081–1088 (table of contents).
51.
go back to reference Guedel AE, Waters RM. New intratracheal catheter. Curr Res Anes Anal. 1928;7:238–89. Guedel AE, Waters RM. New intratracheal catheter. Curr Res Anes Anal. 1928;7:238–89.
Metadata
Title
Endotracheal tube cuff-small important part of a big issue
Authors
Shai Efrati
Israel Deutsch
Gabriel M. Gurman
Publication date
01-02-2012
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 1/2012
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-011-9333-x

Other articles of this Issue 1/2012

Journal of Clinical Monitoring and Computing 1/2012 Go to the issue