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LETTER TO THE EDITOR

Is Capnometry the Optimum Method for Assessing the Adequacy of Endotracheal Tube Cuff Seal?

Board Certified Anesthesiologist, Lafayette Hill, PA, mitchelsosis{at}hotmail.com

To the Editor:

Efrati et al. (1) recently proposed a new technique for assessing the adequacy of endotracheal tube cuff seal on the basis of upper airway capnometry at three sites. The cuffs were inflated until a leak of 2 mm Hg of carbon dioxide was detected. This was compared to the "standard" technique of filling the cuffs by listening for a leak and by comparing inspired and expired tidal volumes. They concluded that capnographic sampling of carbon dioxide via a nasal cannula could "objectively" detect an inadequately inflated endotracheal tube cuff in a patient undergoing general orotracheal anesthesia.

Carbon dioxide is not always detected via a nasal cannula in spontaneously breathing non-intubated patients. The reason, of course, is that the patient can choose to breathe through the mouth. Unless the mouth is somehow sealed in intubated patients, it seems that there is no guarantee that a nasal cannula would detect carbon dioxide leaking past the endotracheal tube cuff.

In the clinical limb of this study, Efrati et al. compared the proposed capnometric technique to the standard technique. The authors noted a slightly lower mean cuff pressure (25.2 ± 3.6 versus 18.2 ± 7.8) with capnography. However, it is not clear whether clinicians were blinded as to cuff pressures, and/or attempted to minimize those pressures, when using the standard technique. The authors did not assess postoperative sore throat, aspiration, or other sequelae of endotracheal intubation. Consequently, no clinical benefit of the capnometric technique was demonstrated.

Reference

1. Efrati S, Leonov Y, Oron A, et al. Optimization of endotracheal tube cuff filling by continuous upper airway carbon dioxide monitoring. Anesth Analg 2005; 101:1081–8.[Abstract/Free Full Text]

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				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]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Sosis, M. B. Search for Related Content PubMed PubMed Citation Articles by Sosis, M. B.