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LETTER TO THE EDITOR

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

Department of Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel, efratishai{at}013.net.il

In Response:

We thank Dr. Sosis for his comments (1) concerning the measurements of CO₂ through the nares. CO₂ readings through the nares could be obtained only when the mouth was closed. We must again emphasize, as detailed in the manuscript (2), that in order to receive an accurate CO₂ reading in the range of 0 to 5 mm Hg, the capnograph routinely used an algorithm to detect if end-tidal CO₂ should be disabled so that direct measurements are displayed.

Regarding the clinically determined cuff pressure, the pressure was continuously displayed on the screen while the anesthesiologist attempted to set the optimal cuff pressure. Although the use of the "standard" technique was not blinded, in 72% of the patients, the primary endotracheal tube cuff pressures were significantly higher than the optimal cuff pressure determined by CO₂ readings, with a mean difference of 10.2 mm Hg. An accurate primary cuff pressure was achieved by the anesthesiologists only in 15% of the patients.

This was a primary study to establish a new objective method for optimizing endotracheal tube cuff pressure. Clinical end-points (e.g., postoperative sore throat, aspiration, mucosal edema, mucosal ulceration, or ventilation-associated pneumonia) were beyond the scope of this study. Further studies are needed to evaluate whether using CO₂ leakage to set cuff pressure prevents complications from inappropriate cuff pressure in patients receiving prolonged mechanical ventilation.

References

1. Sosis MB. Is capnometry the optimum method for assessing the adequacy of endotracheal tube cuff seal? Anesth Analg 2006;103:505.[Free Full Text]
2. 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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