Postoperative Complications Related to Endotracheal Intubation
Conditions
Keywords
cuffed endotracheal tube, intracuff pressure, pressure transducer
Brief summary
Tracheal tube cuff pressure in the range of 20 to 30 cmH2O is considered safe, but it is quite common to encounter cuff pressure outside this range in patients with tracheal intubation. Moreover, objective cuff pressure measurement and monitoring are not routinely applied, especially in general anesthesia practice. Overinflation of the cuff can potentially impair tracheal mucosal blood flow. This may lead to various tracheal injuries such as mucosal inflammation, mucosal ischemia, tracheal ulceration, tracheal stenosis, tracheoesophageal fistula, and tracheal rupture. Conversely, inadequate cuff inflation can lead to inadequate ventilation and microaspiration. The importance of routine cuff pressure measurement and pressure adjustment to keep the pressure in the desired range is emphasized in preventing such side effects in intubated patients. Despite this recommendation for routine intracuff pressure measurement, the methods used to measure and monitor cuff pressure vary from subjective estimation techniques to objective measurements, and there is a lack of specific protocols and documents in the current literature. For this purpose, in this study, it was aimed to perform continuous cuff pressure measurement monitoring using the transducer of the invasive pressure monitoring device, which is routinely used in arterial or central venous pressure monitoring, and to test the effectiveness of this method in reducing cuff-related complications including sore throat, hoarseness, and dysphagia compared to the intermittent monitoring method.
Interventions
DEVICEEndotracheal tube cuff pressure monitoring
The endotracheal tube cuff pressure was continuously monitored using a transducer from a standard invasive pressure monitoring device that is routinely used to measure arterial or central venous pressure.
Sponsors
Cukurova University
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Inclusion criteria
* 18-65 years of age adult patients * Elective non-head-neck surgical procedures under nitrous oxide (N2O)-free general anesthesia * Patients orally intubated with a cuffed endotracheal tube facilitated by neuromuscular blockers * Surgeries with neutral head-neck position
Exclusion criteria
* Emergency surgery * Laparoscopic surgery * Head and neck surgeries including nose, mouth, pharynx, larynx and throat * Surgeries with non-supine patient position * Patients with preoperative sore throat, cough, hoarseness or dysphagia, history of smoking, asthma or COPD, severe cardiovascular disease, inability to obtain consent, having any lesions detected in the pharynx or larynx during laryngoscopy * Use of double lumen tracheal tube * Use of a naso- or orogastric tube or any pharyngeal catheter * Intraoperative nitrous oxide use * Difficult intubation or repeated endotracheal intubation attempt * Patients who strain during endotracheal extubation * High PEEP (greater than 5 cmH2O) application
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of postoperative sore throat | Postoperative 2 and 24 hours | The incidence of endotracheal tube-related complication defined as sore throat during postoperative 2 and 24 hours. |
| Incidence of postoperative hoarseness | Postoperative 2 and 24 hours | The incidence of endotracheal tube-related complication defined as hoarseness during postoperative 2 and 24 hours. |
| Incidence of postoperative dysphagia | Postoperative 2 and 24 hours | The incidence of endotracheal tube-related complication defined as dysphagia during postoperative 2 and 24 hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Identification of predictive factors related to endotracheal tube-related complications | During postoperative 24 hours | Identification of patient and operative characteristics and mechanical ventilation related factors that influence ETT-related complications. |
Countries
Turkey (Türkiye)
Outcome results
None listed