[Control of the endotracheal cuff balloon pressure as a method of preventing laryngotracheal lesions in critically ill intubated patients].

OBJECTIVES

To study the development of tracheal stenosis after endotracheal intubation, percutaneous tracheotomy or both; to assess risk factors for tracheal stenosis and the relation of risk to endotracheal cuff pressure.

PATIENTS AND METHODS

A prospective study enrolling patients sustaining endotracheal intubation longer than 8 hours and/or undergoing percutaneous tracheotomy. Cuff pressure was recorded at the moment of intubation and every 8 hours thereafter; a ceiling of 25 mm Hg was targeted. The patients were examined 6 months after discharge.

RESULTS

Sixteen percutaneous tracheotomies were performed in the 95 patients enrolled (58 men, 37 women). The mean age was 54.1 +/- 19.7 years. The mean APACHE II score for all patients was 16.3 +/- 7.7 and the mean intubation time was 7.3 +/- 11 days, whereas the respective means for patients undergoing percutaneous tracheotomy were 18.4 +/- 7.6 and 20.5 +/- 19 days. Six months after discharge, 55 patients were examined for laryngotracheal lesions by fiberoptic endoscopy. Twenty-three of the remaining patients had died, 7 were lost to follow-up and 10 were only interviewed by telephone. Fiberoptic laryngotracheal endoscopy revealed minimal scarring and reduction of the endotracheal lumen. Reduction of the lumen was observed only in patients who had undergone percutaneous tracheotomy.

CONCLUSIONS

Monitoring cuff pressure three times per day seems to contribute to preventing ischemic lesions and tracheal stenosis.