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TECHNOLOGY, COMPUTING, AND SIMULATION

Optimization of Endotracheal Tube Cuff Filling by Continuous Upper Airway Carbon Dioxide Monitoring

Shai Efrati, MD^*, Yuval Leonov, MD, Amir Oron, MD, Yariv Siman-Tov, DVM^,, Michael Averbukh, MD^*, Alex Lavrushevich, MD^||, and Ahuva Golik, MD^*

*Department of Medicine A, Critical Care Unit, Orthopedic Department, Experimental Research Laboratory, and ||Department of Anesthesia, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel-Aviv University, Israel

Address correspondence and reprint requests to Shai Efrati, MD, Department of Medicine A, Assaf Harofeh Medical Center, Zerifin, 70300, Israel. Address e-mail to efratishai{at}013.net.il.

Inappropriate cuff filling is responsible for various complications related to the use of an endotracheal tube (ETT). In this study, we evaluated an objective, noninvasive method for continuous assessment of leak around the ETT cuff by monitoring carbon dioxide pressure (Pco₂) in the upper airway. Pco₂ levels were measured by capnography simultaneously between the ETT cuff and the vocal cords, at the oropharynx, and in the nares of the nose. Cuff filling was regulated by an electronic controller to achieve the minimal pressure needed to prevent CO₂ leak. Feasibility of the method was assessed in a human simulator and in a porcine model. Clinical function was evaluated in 60 patients undergoing surgery, comparing the method to the standard anesthesiologist evaluation. Linear correlations were observed between the ETT cuff pressure and Pco₂ level in the human simulator (R² = 0.954, P < 0.0001) and in the porcine model (R² > 0.98, P < 0.0001). Iodine leak around the ETT cuff, in the porcine model, occurred only when Pco₂ levels were >2 mm Hg. In the surgery patients, the mean ETT cuff pressure determined clinically by the anesthesiologist was significantly higher than the optimal cuff pressure assessed by Pco₂ (25.2 ± 3.6 versus 18.2 ± 7.8 mm Hg, respectively; P < 0.001). According to these findings, optimal ETT cuff filling pressure can be identified by monitoring Pco₂ at the nares or the oropharynx.

This article has been cited by other articles:

				M. B. Sosis Is capnometry the optimum method for assessing the adequacy of endotracheal tube cuff seal? Anesth. Analg., August 1, 2006; 103(2): 505 - 505. [Full Text] [PDF]

				S. Efrati Is Capnometry the Optimum Method for Assessing the Adequacy of Endotracheal Tube Cuff Seal? Anesth. Analg., August 1, 2006; 103(2): 505 - 506. [Full Text] [PDF]