Minimal occlusive volume is a safe and effective method for adjusting cuff pressure in mechanically ventilated patients
DOI:
https://doi.org/10.1590/1809-2950/220130311022PTKeywords:
Pneumonia, Ventilator-Associated, Airway Management, Intensive Care UnitsAbstract
The ideal cuff pressure (Pcuff) must prevent
microaspiration of oropharyngeal secretions due to air leakage
and avoid injury to the tracheal mucosa. Usually, monitoring
consists of a manometer to keep the Pcuff between 20 and
30cmH2
O. The minimal occlusive volume (MOV) method
minimally inflates the cuff using a syringe so that no leakage
occurs. This study aims to evaluate the ability of the minimal
occlusive method to individualize the Pcuff adjustment in
mechanically ventilated patients. Cross-sectional prospective
study with 25 adult patients with more than 48 hours of
mechanical ventilation. Cuff pressure was measured at
two moments: initial and by MOV. The prevalence of Pcuff
outside the normal range was 76%. Leakage in the initial
measurement occurred in 9 patients, 4 of whom were
within the reference values. The other 5 patients presented
Pcuff<20cmH2
O. In the adjustment by the MOV method, all patients presented Pcuff at the limit of normality. Patients without
leakage with Pcuff>30cmH2
O had a reduction when adjusted for MOV
(45.4±9.6 against 28.5±1.6cmH2
O; p<0.001). We can conclude that
the minimal occlusive volume method was able to individualize the
Pcuff within the reference values in all patients.
Downloads
References
Branson RD, Gomaa D, Rodriquez D Jr. Management
of the artificial airway. Respir Care. 2014;59(6):974-90.
doi: 10.4187/respcare.03246.
Dexter AM, Scott JB. Airway management and ventilatorassociated events. Respir Care. 2019;64(8):986-93.
doi: 10.4187/respcare.07107.
Papazian L, Klompas M, Luyt CE. Ventilator-associated
pneumonia in adults: a narrative review. Intens Care Med.
;46(5):888-906. doi: 10.1007/s00134-020-05980-0.
Rouzé A, Martin-Loeches I, Nseir S. Airway devices in ventilatorassociated pneumonia pathogenesis and prevention. Clin Chest
Med. 2018;39(4):775-83. doi: 10.1016/j.ccm.2018.08.001.
Nseir S, Zerimech F, Fournier C, Lubret R, Ramon P, et al.
Continuous control of tracheal cuff pressure and microaspiration
of gastric contents in critically ill patients. Am J Respir Crit
Care Med. 2011;184(9):1041-7. doi: 10.1164/rccm.201104-0630OC.
Wen Z, Wei L, Chen J, Xie A, Li M, et al. Is continuous better than
intermittent control of tracheal cuff pressure? A meta-analysis.
Nurs Crit Care. 2019;24(2):76-82. doi: 10.1111/nicc.12393.
Kumar A, Kumar N. Endotracheal tube inflation tubing defect:
an unusual cause of intraoperative volume leak. J Clin Monit
Comput. 2021;35(5):1239-40. doi: 10.1007/s10877-020-00607-7.
Gil-Perotin S, Ramirez P, Marti V, Sahuquillo JM, Gonzalez E,
et al. Implications of endotracheal tube biofilm in ventilatorassociated pneumonia response: a state of concept. Crit Care.
;16(3):R93. doi: 10.1186/cc11357.
Camargo MF, Andrade APA, Cardoso FPF, Melo MHO.
Analysis of the intracuff pressures of intensive care
patients. Rev Assoc Med Bras. 2006;52(6):405-8.
doi: 10.1590/S0104-42302006000600019.
Godoy ACF, Moura MG, Adame ML, Fraga GP. Tailored
intracuff pressures. J Bras Pneumol. 2012;38(5):672-3.
doi: 10.1590/s1806-37132012000500018.
Chair SY, Chan DWK, Cao X. The interaction of subglottic
drainage, cuff pressure, and oral care on endotracheal tube fluid
leakage: a benchtop study. Aust Crit Care. 2020;33(4):358-63.
doi: 10.1016/j.aucc.2019.05.002.
Barbas CSV, Ísola AM, Farias AMC, Cavalcanti AB, Gama AMC,
et al. Brazilian recommendations of mechanical ventilation
Part I. Rev Bras Ter Intensiva. 2014;26(2):89-121.
doi: 10.5935/0103-507x.20140017.
Hellyer TP, Ewan V, Wilson P, Simpson AJ. The Intensive
Care Society recommended bundle of interventions for the
prevention of ventilator-associated pneumonia. J Intensive
Care Soc. 2016;17(3):238-43. doi: 10.1177/1751143716644461.
Chicayban LM, Terra ELVS, Ribela JS, Barbosa PF. Bundles de
prevenção de pneumonia associada à ventilação mecânica:
a importância da multidisciplinaridade. Perspect Online Biol
Saude. 2017;7(25):25-35. doi: 10.25242/886872520171200.
Akdogan O, Ersoy Y, Kuzucu C, Gedik E, Togal T. Assessment
of the effectiveness of a ventilator associated pneumonia
prevention bundle that contains endotracheal tube with
subglottic drainage and cuff pressure monitorization. Braz J
Infect Dis. 2017;21(3):276-81. doi: 10.1016/j.bjid.2017.01.002.
O’Neill MP, Gopalan PD. Endotracheal tube cuff pressure change:
proof of concept for a novel approach to objective cough
assessment in intubated critically ill patients. Heart Lung.
;49(2):181-5. doi: 10.1016/j.hrtlng.2019.10.013.
Jerre G, Silva TJ, Beraldo MA, Gastaldi A, Kondo C,
et al. Fisioterapia no paciente sob ventilação mecânica.
J Bras Pneumol. 2007;33(Suppl 2):S142-50. doi: 10.1590/
S1806-37132007000800010.
Castilho EC, Braz JRC, Catâneo AJM, Martins RHG, Gregório EA.
Effects of tracheal tube cuff limit pressure (25 cmH2
O) and
“seal” pressure on tracheal mucosa of dogs. Rev Bras Anestesiol.
;53(6):743-55. doi: 10.1590/s0034-70942003000600006.
Diaconu O, Siriopol I, Poloșanu LI, Grigoraș I. Endotracheal
tube biofilm and its impact on the pathogenesis of ventilatorassociated pneumonia. J Crit Care Med (Targu Mures).
;4(2):50-5. doi: 10.2478/jccm-2018-0011.
Wittekamp BHJ, van Mook WNKA, Tjan DHT, Zwaveling JH,
Bergmans DCJJ. Clinical review: post-extubation laryngeal
edema and extubation failure in critically ill adult patients. Crit
Care. 2009;13(6):233. doi: 10.1186/cc8142.
Spapen H, Suys E, Regt J, Troubleyn J, Jonckheer J.
An endotracheal tube providing “pressurized sealing”
prevents fluid leakage in mechanically ventilated critically
ill patients: a pilot study. J Anesth. 2020;34(1):144-8.
doi: 10.1007/s00540-019-02707-4.
Ono FC, Andrade APA, Cardoso FPF, Melo MHO, Souza RN,
et al. Cuff pressure analysis of intensive care unit patients
with different inclinations of the head section of the bed.
Rev Bras Ter Intensiva. 2008;20(3):220-5. doi: 10.1590/
S0103-507X2008000300003.
Aranha AGA, Forte V, Perfeito JAJ, Leão LEV, Imaeda CJ, et al.
Study of tracheal tube intra-cuff pressure. Rev Bras Anestesiol.
;53(6):728-36. doi: 10.1590/s0034-70942003000600004
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Bruno Santos Silva de Souza, Thiago Augusto Guimarães Souza, Caroline Ferreira dos Santos, Patrícia Barbirato Chicayban, Luciano Matos Chicayban
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
