Do lower cuff pressures reduce damage to the tracheal mucosa? A scanning electron microscopy study in neonatal pigs. Issue 2 (9th November 2012)

• Record Type: Journal Article
• Authors: Kutter, Annette P. N.; Bittermann, Anne G.; Bettschart‐Wolfensberger, Regula; Spielmann, Nelly; Hartnack, Sonja; Ziegler, Urs; Weiss, Markus; Mauch, Jacqueline Y.; Davidson, Andrew
• Is Part Of: Paediatric anaesthesia. Volume 23:Issue 2(2013)
• Page Start: 117
• Page End: 121
• Publication Date: 2012-11-09
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12066
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12066-abs-0001"> <title>Summary</title> <sec id="pan12066-sec-0001" sec-type="section"> <title>Background</title> <p>Modern high volume–low pressure (HVLP) endotracheal tubes (ETT) cuffs can seal the trachea using baseline cuff pressures (CP) lower than peak inspiratory airway pressures (PIP). The aim of the study was to determine whether this technique reduces the damage to the tracheal mucosa compared to constant CP of 20 cmH<sub>2</sub>O.</p> </sec> <sec id="pan12066-sec-0002" sec-type="section"> <title>Methods</title> <p>Eighteen piglets were intubated with an ID 4.0 mm HVLP cuffed ETT (Microcuff PET) and artificially ventilated with 20 cmH<sub>2</sub>O PIP and 5 cmH<sub>2</sub>O PEEP. Animals were randomly allocated to two groups of CP: group A (just seal; <italic>n </italic>= 9) and group B (20 cmH<sub>2</sub>O; <italic>n </italic>= 9), controlled constantly with a manometer during the following 4‐h study period under sevoflurane anesthesia. After euthanasia, cuff position was marked in situ. Damage in the cuff region was evaluated with scanning electron microscopy (SEM) examination by grading of mucosal damage and by estimating percentage of intact mucosal area both by a blinded observer.</p> </sec> <sec id="pan12066-sec-0003" sec-type="section"> <title>Results</title> <p>Maximal CP to seal the trachea in group A ranged from 12 to 18 cmH<sub>2</sub>O (median: 14 cmH<sub>2</sub>O). Using a mixed effects model approach, the estimated mean effect of group B vs group A was an increase of 17.9% (SE 8.1%) higher proportion of pictures with an area of at least 5% intact mucosa (<italic>P </italic>= 0.042).</p> </sec> <sec id="pan12066-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Minimal sealing pressures with cyclic pressure changes from CP did not result in decreased damage to the tracheal mucosa compared to constant CP of 20 cmH<sub>2</sub>O in this short‐term animal trial.</p> </sec> </abstract>