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CRITICAL CARE AND TRAUMA

Pressures Exerted by Endobronchial Devices

From the Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario.

BACKGROUND: High endotracheal cuff pressures have been shown to cause high mucosal pressures and a reduction in mucosal blood flow, with the risk of mucosal ischemia. We aimed to directly measure the pressure exerted by the bronchial cuffs of double-lumen tubes (DLT) and by the cuffs of three new designs of endobronchial blocker (EBB).

METHODS: Using a validated in vitro model and a previously described technique, we measured the static pressures exerted by the cuff of DLTs and EBBs with 1 mL increments in cuff volume until maximum inflation was achieved. The study was repeated under dynamic conditions of simulated positive pressure ventilation.

RESULTS: The pressures exerted by the cuffs of DLTs ranged from 16–155 mm Hg. Pressures exerted by the EBB cuffs ranged from 39–194 mm Hg. At intra-cuff volumes required to create a seal to 25 cm H₂O positive pressure, the pressures exerted by the cuffs of all the devices were <30 mm Hg.

CONCLUSIONS: A transmitted pressure <30 mm Hg has been recommended to avoid mucosal injury. Our study shows that at clinically relevant cuff volumes, the pressures exerted by the cuffs do not exceed the recommended safe limit.

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