Moon Kelly, Kitio Sibelle Aurelie Yemele, Rice-Weimer Julie, Tobias Joseph D
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Paediatr Anaesth. 2025 Nov;35(11):940-945. doi: 10.1111/pan.70045. Epub 2025 Sep 5.
Endotracheal tube (ETT) cuff pressures that exceed 20-30 cmHO may lead to iatrogenic adverse effects such as cough, sore throat, and tracheal edema or more serious complications including tracheal stenosis, recurrent laryngeal nerve injury, and tracheal rupture. The current study evaluates a novel technique, titration of the ratio of expiratory to inspiratory tidal volumes (TV), to regulate intracuff pressure.
This prospective, cross-over trial measured intracuff pressure in a cohort of pediatric patients presenting for general anesthesia with an ETT. Intracuff pressure was measured following adjustment of the expiratory to inspiratory TV to various ratios (1.0, 0.9, and 0.8) by slow removal of air from the ETT cuff.
The study cohort included 50 patients with a median age of 12 years. At baseline continuous positive airway pressure (CPAP), the median (IQR) intracuff pressure was 20.4 cmHO (13.6, 28.8). The intracuff pressure decreased to 12.2 cmHO (10.2, 18.4) at an expired tidal volume (TV) to inspired tidal volume (TV) ratio of 1, 8.9 cmHO (7.4, 10.9) at 0.9, and to 8.2 cmHO (6.8, 9.5) at a ratio of 0.8. With both the CPAP method and TVe/TVi ratio of 1, there were cuff pressures greater than 30 cmHO (10 with CPAP and 2 with TVe/TVi ratio of 1). With a TVe/TVi ratio of 0.9 or 0.8, there were no cuff pressures greater than 30 cmHO.
Adjustment of the TVe/TVi may be a more effective means of ensuring that the cuff pressure is in the desired range than other conventionally used clinical techniques such as sealing the airway to a CPAP of 20 cmHO.
ClinicalTrials.gov: NCT02768831.
气管内导管（ETT）套囊压力超过20 - 30 cmH₂O可能会导致医源性不良影响，如咳嗽、咽痛和气管水肿，或更严重的并发症，包括气管狭窄、喉返神经损伤和气管破裂。本研究评估了一种新技术，即通过调整呼气与吸气潮气量（TV）的比值来调节套囊内压力。
这项前瞻性交叉试验测量了一组接受全身麻醉并使用ETT的儿科患者的套囊内压力。通过缓慢从ETT套囊中抽出空气，将呼气与吸气TV调整到不同比值（1.0、0.9和0.8）后测量套囊内压力。
研究队列包括50名患者，中位年龄为12岁。在基线持续气道正压通气（CPAP）时，套囊内压力的中位数（IQR）为20.4 cmH₂O（13.6，28.8）。呼气潮气量（TV）与吸气潮气量（TV）比值为1时，套囊内压力降至12.2 cmH₂O（10.2，18.4）；比值为0.9时，降至8.9 cmH₂O（7.4，10.9）；比值为0.8时，降至8.2 cmH₂O（6.8，9.5）。采用CPAP方法和TVe/TVi比值为1时，均有套囊压力大于30 cmH₂O的情况（CPAP时有10例，TVe/TVi比值为1时有2例）。TVe/TVi比值为0.9或0.8时，无套囊压力大于30 cmH₂O的情况。
与其他传统临床技术（如将气道密封至20 cmH₂O的CPAP）相比，调整TVe/TVi可能是确保套囊压力处于理想范围的更有效方法。
ClinicalTrials.gov：NCT02768831。
