Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Samina Mir

doi:doi:10.11648/j.ijacm.20231101.19

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Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery

Samina Mir

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)

Received: 2 May 2023 Accepted: 18 May 2023 Published: 6 June 2023

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Abstract

Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH₂O to 110 cmH₂O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH₂O, 23% of patients had normal cuff pressure between 20 to 30 cmH₂O, and 63% had more than normal pressure which was more than 30 cmH₂O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH₂O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH₂O.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI	10.11648/j.ijacm.20231101.19
Page(s)	38-43
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Endotracheal Intubation, General Anesthesia, Cuff Pressure Measurement, Cuff Volume Assessment

References

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APA Style

Samina Mir. (2023). Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. International Journal of Anesthesia and Clinical Medicine, 11(1), 38-43. https://doi.org/10.11648/j.ijacm.20231101.19

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ACS Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int. J. Anesth. Clin. Med. 2023, 11(1), 38-43. doi: 10.11648/j.ijacm.20231101.19

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AMA Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int J Anesth Clin Med. 2023;11(1):38-43. doi: 10.11648/j.ijacm.20231101.19

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@article{10.11648/j.ijacm.20231101.19,
  author = {Samina Mir},
  title = {Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {38-43},
  doi = {10.11648/j.ijacm.20231101.19},
  url = {https://doi.org/10.11648/j.ijacm.20231101.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.19},
  abstract = {Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.},
 year = {2023}
}

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TY  - JOUR
T1  - Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery
AU  - Samina Mir
Y1  - 2023/06/06
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.19
DO  - 10.11648/j.ijacm.20231101.19
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.19
AB  - Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.
VL  - 11
IS  - 1
ER  -

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Author Information

Samina Mir

Department of Anaesthesia, Aga Khan University, Nairobi, Kenya

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APA Style

Samina Mir. (2023). Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. International Journal of Anesthesia and Clinical Medicine, 11(1), 38-43. https://doi.org/10.11648/j.ijacm.20231101.19

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ACS Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int. J. Anesth. Clin. Med. 2023, 11(1), 38-43. doi: 10.11648/j.ijacm.20231101.19

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AMA Style

Samina Mir. Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery. Int J Anesth Clin Med. 2023;11(1):38-43. doi: 10.11648/j.ijacm.20231101.19

Copy | Download

@article{10.11648/j.ijacm.20231101.19,
  author = {Samina Mir},
  title = {Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {38-43},
  doi = {10.11648/j.ijacm.20231101.19},
  url = {https://doi.org/10.11648/j.ijacm.20231101.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.19},
  abstract = {Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Evaluation of Endotracheal Cuff Pressure and Volume of Air for Inflation of CUFF Following Intubation After General Anaesthesia for Elective Surgery
AU  - Samina Mir
Y1  - 2023/06/06
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.19
DO  - 10.11648/j.ijacm.20231101.19
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.19
AB  - Background: Endotracheal intubation is part of general anesthesia. The endotracheal cuff situated near the end of the tube is inflated following successful intubation (above the carina) to secure the airway. A critical function of the endotracheal tube (ETT) cuff during general anesthesia is to seal the airway thus preventing aspiration of pharyngeal contents into the trachea and leaks during positive pressure ventilation. From the literature, we know that excessive cuff pressure decreases tracheal capillary perfusion which has the potential to lead to endothelial necrosis, while insufficient cuff pressure leads to pulmonary aspiration of oro-pharyngeal contents and leads to ventilator-associated pneumonia and pulmonary pneumonitis. Methodology: All the patients above the age of 18 years who presented to The Aga Khan University Hospital, Nairobi for elective surgical procedures under general anesthesia and requiring endotracheal intubation for the surgical procedure were included in the audit. Patients were induced and intubated according to routine practice by the attending anesthesiologist and the cuff was subsequently inflated by the anesthetic assistant, anesthesia resident, instructor, or consultant anesthesiologist. Patients were maintained with volatile anesthetic agents or total intravenous anesthesia in a mixture of oxygen and air according to the anesthesiologist’s choice. The volume of the air used to inflate the cuff was recorded and the intra-cuff pressure was measured by one of the investigators after securing the endotracheal tube (before positioning the patient) with an aneroid manometer connected to the pilot balloon of the ETT cuff. Results: The volume of air used to inflate the endotracheal cuff was in the range of 3ml and 15ml with the mean volume being 7.64 ml, median of 8ml, and mode of 10ml. The resultant cuff pressure ranged between 10 cmH2O to 110 cmH2O with a median of 40 ml and mode of 22 ml. Overall 14% of the total patients had intra-cuff pressure of less than normal which is below 20 cmH2O, 23% of patients had normal cuff pressure between 20 to 30 cmH2O, and 63% had more than normal pressure which was more than 30 cmH2O. Conclusion: The average volume of air inflated for the endotracheal cuff was 7.64 ml and the cuff pressure was 46.71 cmH2O. Recommendations: The endotracheal tube cuff is inflated under the guidance of a manometer to a target pressure of 20-30 cmH2O.
VL  - 11
IS  - 1
ER  -

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