Does the endotracheal tube cuff pressure increases with transesophageal probe insertion?

CONTEXT

The cuff pressure (CP) of the endotracheal tube (ETT) exceeding 30 cm of HO results in reduced perfusion of lateral mucosa of trachea leading to complications. As the posterior tracheal wall is in contact with the esophagus, there is a possibility that the insertion of transesophageal echo (TEE) probe may compress the tracheal wall and increase CP.

AIMS

This study was aimed to assess the impact of TEE probe insertion on CP in adults undergoing cardiac surgery.

SETTINGS AND DESIGN

Prospective observational study of 65 patients at tertiary care level hospital.

SUBJECTS AND METHODS

After balanced general anesthesia, patients were intubated with high volume low-pressure ET.TEE probe was then inserted with gentle jaw thrust. CP was measured by standard invasive pressure monitoring device at four points: T1 at baseline before TEE probe insertion; T2 maximum CP noted at TEE probe insertion; T3 at 5 min post TEE probe insertion; and T4 at post-TEE exam.

STATISTICAL ANALYSIS USED

CP was compared between pairs of time points (T1 vs. T2; T1 vs. T3; and T1 vs. T4) using Mann-Whitney U test. Factors predicting CP >30 cm of HO at T4 were assessed by backward stepwise regression.

RESULTS

CP (mean ± S.D.) at T1, T2, T3, and T4 was 22 ± 3, 38 ± 10, 30 ± 6, and 30 ± 7, respectively. CP increased significantly from T1 to T2 (P < 0.001), T1 to T3 (P < 0.001), and T1 to T4 (P < 0.001). There were 26 patients (40%) with CP >30 cm of HO at end of TEE exam (T4). On multivariate analysis baseline, CP (T1) >20 cm of HO was significantly associated with CP >30 cm of HO at end of TEE exam with Odd's Ratio (OR) of 8.5 (1.76-41.06, P = 0.008).

CONCLUSIONS

To conclude, the CP increases significantly with TEE probe insertion in 40% of patients exceeding a safe limit of 30 cm of HO. The monitoring and optimization of CP is advisable.