Tracheal stenosis is caused by mucosal ischemic injury. Contrary, aspiration of upper airway secretion and impaired gas exchange due to cuff leakage is related to low Pcuff. To prevent these complications, Pcuff should be kept appropriately. But the constant cuff volume(Vcuff) has been frequently instilled to the cuff balloon to maintain the optimal Pcuff. To address the necessity of continuous Pcuff monitoring, we evaluated the change of Pcuff in various level of Vcuff daily basis in patients with long-term mechanical ventilation. We also investigated the usefulness of mercury column sphygmomanometer for the continuous Pcuff monitoring.
In 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more, we observed the change of Pcuff according to the increase in Vcuff. We repeated this maneuvor measuring the change of Pcuff daily during mechanical ventilation days. And we compared the Pcuff measured by mercury column sphygmomanometer with the Pcuff measured by automatic cuff pressure manager.
There was no statistically significant changes of Pcuff during more than 14 days of intubation for mechanical ventilation. However the Vcuff required to maintain the appropriate Pcuff vary from 1.9 cc to 9.6 cc individually. And the intra-individual variation of the Pcuff was observed from 10 cmH2O to 46 cmH2O at constant 3 cc Vcuff. The Pcuff measured by bedside mercury column sphygmomanometer is well coincident with that measured by automatic cuff.
It is thought that continuous monitoring and management of Pcuff should be necessary to maintain the appropriate level of Pcuff for preventing cuff related problems during long-term mechanical ventilation. For this purpose, mercury column sphygmomanometer could replace the specific cuff pressure monitoring equipment.
It’s known that appropriate Pcuff managements can prevent cuff related complications of endotracheal tube. But Pcuff seems to change according to patient’s respiratory mechanics. Therefore the constant cuff volume(Vcuff) instillation maneuvor may be inappropriate to maintain the optimal Pcuff and continuous Pcuff monitoring is necessary.
B.H. Jung, None.