Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs.

TLDR

Large volume, low‑pressure endotracheal tube cuffs are thought to be gentler on tracheal mucosa, yet they can be overinflated to pressures that exceed capillary perfusion pressure. The study examined several large‑volume cuffed tubes (Portex Profile, Searle Sensiv, Mallinkrodt Hi‑Lo, Lanz) and measured tracheal mucosal blood flow in 40 surgical patients using an endoscopic photographic technique while varying cuff inflation pressure. Cuff overinflation was found to impair mucosal blood flow, a key contributor to intubation‑related tracheal morbidity, and the authors recommend keeping cuff pressure below 30 cm H₂O.

Abstract

Large volume, low pressure endotracheal tube cuffs are claimed to have less deleterious effect on tracheal mucosa than high pressure, low volume cuffs. Low pressure cuffs, however, may easily be overinflated to yield pressures that will exceed capillary perfusion pressure. Various large volume cuffed endotracheal tubes were studied, including Portex Profile, Searle Sensiv, Mallinkrodt Hi-Lo, and Lanz. Tracheal mucosal blood flow in 40 patients undergoing surgery was assessed using an endoscopic photographic technique while varying the cuff inflation pressure. It was found that these cuffs when overpressurised impaired mucosal blood flow. This impairment of tracheal mucosal blood flow is an important factor in tracheal morbidity associated with intubation. Hence it is recommended that a cuff inflation pressure of 30 cm H2O (22 mm Hg) should not be exceeded.