Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management

Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management

Author Bolzan, Douglas Willian Autor UNIFESP Google Scholar
Gomes, Walter José Autor UNIFESP Google Scholar
Faresin, Sonia Maria Autor UNIFESP Google Scholar
Carvalho, Antonio Carlos de Camargo Autor UNIFESP Google Scholar
Paola, Angelo Amato Vincenzo de Autor UNIFESP Google Scholar
Guizilini, Solange Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Pirajussara Hosp
São Paulo Hosp
Abstract BACKGROUND: Despite numerous studies on endotracheal tube cuff pressure (CP) management, the literature has yet to establish a technique capable of adequately tilling the cuff with an appropriate volume of air while generating low CP in a less subjective way. the purpose of this prospective study was to evaluate and compare the CP levels and air volume required to fill the endotracheal tubes cuff using 2 different techniques (volume-time curve versus minimal occlusive volume) in the immediate postoperative period after coronary artery bypass grafting. METHODS: A total of 267 subjects were analyzed. After the surgery, the lungs were ventilated using pressure controlled continuous mandatory ventilation, and the same ventilatory parameters were adjusted. Upon arrival in the ICU, the cuff was completely deflated and re-inflated, and at this point the volume of air to fill the cuff was adjusted using one of 2 randomly selected techniques: volume-time curve and minimal occlusive volume. We measured the volume of air injected into the cuff, the CP, and the expired tidal volume of the mechanical ventilation after the application of each technique. RESULTS: the volume-time curve technique demonstrated a significantly lower CP and a lower volume of air injected into the cuff, compared to the minimal occlusive volume technique (P < .001). No significant difference was observed in the expired tidal volume between the 2 techniques (P = .052). However, when the subjects were submitted to the minimal occlusive volume technique, 17% (n = 47) experienced air leakage as observed by the volume-time graph. CONCLUSIONS: the volume-time curve technique was associated with a lower CP and a lower volume of air injected into the cuff, when compared to the minimal occlusive volume technique in the immediate postoperative period after coronary artery bypass grafting. Therefore, the volume-time curve may be a more reliable alternative for endotracheal tube cuff management.
Keywords endotracheal tube cuff pressure
air leakage
volume-time curve
minimal occlusive volume technique
cuff pressure management
coronary artery bypass surgery
Language English
Date 2012-12-01
Published in Respiratory Care. Irving: Daedalus Enterprises Inc, v. 57, n. 12, p. 2039-2044, 2012.
ISSN 0020-1324 (Sherpa/Romeo, impact factor)
Publisher Daedalus Enterprises Inc
Extent 2039-2044
Origin http://dx.doi.org/10.4187/respcare.01812
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000312057300007
URI http://repositorio.unifesp.br/handle/11600/35538

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