The relationship between measured cuff pressure and volume of air in the cuff. 2, pp. However, this could be a site-specific outcome. Because one purpose of our study was to measure pressure in the endotracheal tube cuff during routine practice, anesthesia providers were blinded to the nature of the study. 111, no. Evrard C, Pelouze GA, Quesnel J: [Iatrogenic tracheal and left bronchial stenoses. 775778, 1992. A) Normal endotracheal tube with 10 ml of air instilled into cuff. Symptoms of a severe air embolism might include: difficulty breathing or respiratory failure. Precaution was taken to avoid premature detachment of the loss of resistance syringe in this study. All patients who received nondepolarizing muscle relaxants were reversed with neostigmine 0.03mg/kg and atropine 0.01mg/kg at the end of surgery. trachea, bronchial tree and lung, from aspiration. First, inflate the tracheal cuff and deflate the bronchial cuff. Consecutive available patients were enrolled until we had recruited at least 10 patients for each endotracheal tube size at each participating hospital. All patients provided informed, written consent before the start of surgery. 5, pp. Anesthetic officers provide over 80% of anesthetics in Uganda. 8, pp. D) Pressure gauge attached to pilot balloon of defective cuff with reading of 30 mmHg with cuff not appropriately inflated. In certain instances, however, it can be used to. American Society of Anesthesiology, Committee of Origin: Committee on Quality Management and Departmental Administration (QMDA). Cuff pressure should be maintained between 15-30 cm H 2 O (up to 22 mm Hg) . Upon inflation, folds form along the cuff surface, and colonized oropharyngeal secretions may leak through these folds. Martinez-Taboada F. The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. Morphometric and demographic characteristics of the patients were similar at each participating hospital (Table 1). The secondary objective of the study evaluated airway complaints in those who had cuff pressure in the optimal range (2030cmH2O) and those above the range (3140cmH2O). BMC Anesthesiology We therefore also evaluated cuff pressure during anesthesia provided by certified registered nurse anesthetists (CRNAs), anesthesia residents, and anesthesia faculty. 21, no. V. Foroughi and R. Sripada, Sensitivity of tactile examination of endotracheal tube intra-cuff pressure, Anesthesiology, vol. Heart Lung. This single-blinded, parallel-group, randomized control study was performed at Mulago National Referral Hospital, Uganda. 965968, 1984. This method provides a viable option to cuff inflation. Uncommon complication of Carlens tube. One such approach entails beginning at the patient and following the circuit to the machine. 1996-2023, The Anesthesia Patient Safety Foundation, APSF Patient Safety Priorities Advisory Groups, Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi, APSF Prevencin y Manejo de Fuegos Quirrgicos, APSF Prvention et gestion des incendies dans les blocs opratoires, Monitoring for Opioid-Induced Ventilatory Impairment (OIVI), Perioperative Visual Loss (POVL) Informed Consent, ASA/APSF Ellison C. Pierce, Jr., MD Memorial Lecturers, The APSF: Ten Patient Safety Issues Weve Learned from the COVID Pandemic, APSF Technology Education Initiative (TEI), Emergency Manuals Implementation Collaborative (EMIC), Perioperative Multi-Center Handoff Collaborative (MHC), APSF/FAER Mentored Research Training Grant, Investigator Initiated Research (IIR) Grants, Past APSF Consensus Conferences and Recommendations, Conflict in the Operating Room: Impact on Patient Safety Report from the ASA 2016 Annual Meetings APSF Workshop, Distractions in the Anesthesia Work Environment: Impact on Patient Safety. In addition, over 90% of anesthesia care at this hospital was provided by anesthetic officers and anesthesia residents during the study period. ETT exchange could pose significant risk to patients especially in the case of the patient with a difficult airway. mental status changes, such as confusion . Ninety-three patients were randomly assigned to the study. Google Scholar. The study comprised more female patients (76.4%). Inflate the cuff with 5-10 mL of air. If pressure remains > 30 cm H2O, Evaluate . The cuff was considered empty when no more air could be removed on aspiration with a syringe. 686690, 1981. Sengupta, P., Sessler, D.I., Maglinger, P. et al. This study was not powered to evaluate associated factors, but there are suggestions that the levels of anesthesia providers with varying skill set and technique at direct laryngoscopy may be associated with a high incidence of complications. 1999, 117: 243-247. 7 It has been shown that the best way to ensure adequate sealing and avoid underinflation (or overinflation) is to monitor the intracuff pressure periodically and maintain the intracuff pressure within Luna CM, Legarreta G, Esteva H, Laffaire E, Jolly EC: Effect of tracheal dilatation and rupture on mechanical ventilation using a low-pressure cuff tube. Independent anesthesia groups at the three participating hospitals provided anesthesia to the participating patients. They were only informed about the second purpose of the study: determining the relationship between cuff volume and pressure. Crit Care Med. An endotracheal tube , also known as an ET tube, is a flexible tube that is placed in the trachea (windpipe) through the mouth or nose. Previous studies have shown that the incidence of postextubation airway symptoms varies from 15% to 94% in various study populations [7, 9, 11, 27] and could be affected by the method of interview employed, such as the one used in our study (yes/no questions). Conventional high-volume, low-pressure cuffs may not prevent micro-aspiration even at cuff pressures up to 60 cm H2O [2], although some studies suggest that only 25 cm H2O is sufficient [3]. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. Nor did measured cuff pressure differ as a function of endotracheal tube size. The datasets analyzed during the current study are available from the corresponding author on reasonable request. Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal mucosal irritation, tracheal wall ischemia or necrosis, whereas under-inflation increases the risk of pulmonary aspiration as well as leaking anesthetic gas and polluting the environment. 795800, 2010. E. Resnikoff and A. J. Katz, A modified epidural syringe as an endotracheal tube cuff pressure-controlling device, Anaesthesia and Analgesia, vol. After cuff inflation, a persistent significant air leak was noted (> 1 L/min in volume controlled ventilation modality). The study was approved by the School of Medicine Research and Ethics Committee, Makerere University, and registered with http://www.clinicaltrials.gov (NCT02294422). This cookies is installed by Google Universal Analytics to throttle the request rate to limit the colllection of data on high traffic sites. 21, no. T. M. Cook, N. Woodall, and C. Frerk, Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Cuff Pressure Measurement Check the cuff pressure after re-inflating the cuff and if there are any concerns for a leak. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Measured cuff volume averaged 4.4 1.8 ml. 11331137, 2010. Advance the endotracheal tube through the vocal cords and into the trachea within 15 seconds. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. R. J. Hoffman, V. Parwani, and I. H. Hahn, Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques, American Journal of Emergency Medicine, vol. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, http://www.biomedcentral.com/1471-2253/4/8/prepub. (States: would deflate the cuff, pull tube back slightly -1 cm, re-inflate the cuff, and auscultate for bilateral air entry). The authors wish to thank Ms. Martha Nakiranda, Bachelors of Arts in Education, Makerere University, Uganda, for her assistance in editing this manuscript. 31. Air leaks are a common yet critical problem that require quick diagnosis. COPD, head injury, ARDS), Rapid sequence induction (RSI) intubation, Procedural variation using rapid anaesthetisation with cricoid pressure to prevent aspiration while airway is quickly secured, Used for patients at risk of aspiration e.g. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. A pressure manometer is a hand hand held device used to measure tracheostomy tube cuff pressures. Approved by the ASA House of Delegates on October 20, 2010, and last amended on October 28, 2015. K. C. Park, Y. D. Sohn, and H. C. Ahn, Effectiveness, preference and ease of passive release techniques using a syringe for endotracheal tube cuff inflation, Journal of the Korean Society of Emergency Medicine, vol. This is an open access article distributed under the, PBP group (active comparator): in this group, the anesthesia care provider was asked to reduce or increase the pressure in the ETT cuff by inflating with air or deflating the pilot balloon using a 10ml syringe (BD Discardit II) while simultaneously palpating the pilot balloon until a point he or she felt was appropriate for the patient. Although we were unable to identify any statistically significant or clinically important differences among the sites or providers, our results apply only to the specific sites and providers we evaluated. CONSORT 2010 checklist. A systematic approach to evaluation of air leaks is recommended to ensure rapid evaluation and identification of underlying issues. PubMed Chest. J. R. Bouvier, Measuring tracheal tube cuff pressurestool and technique, Heart and Lung, vol. B) Dye instilled into the defective endotracheal tube stops at the entrance of the pilot balloon tubing into the main tubing (arrow in Figure 2A and 2B). Perhaps the LOR syringe method needs to be evaluated against the no air leak on auscultation method. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. These data suggest that tube size is not an important determinant of appropriate cuff inflation volume. 10911095, 1999. The study would be discontinued if 5% of study subjects in one study group experienced an adverse event associated with the study interventions as determined by the DSMB, or if a value of <0.001 was obtained on an interim analysis performed halfway through patient accrual. non-fasted patients, Size: 8mm diameter for men, 7mm diameter for women, Laryngoscope (check size the blade should reach between the lips and larynx size 3 for most patients), turn on light, Monitoring: end-tidal CO2 monitor, pulse oximeter, cardiac monitor, blood pressure, Medications in awake patient: hypnotic, analgesia, short-acting muscle relaxant (to aid intubation), Pre-oxygenate patient with high concentration oxygen for 3-5mins, Neck flexed to 15, head extended on neck (i.e. To detect a 15% difference between PBP and LOR groups, it was calculated that at least 172 patients would be required to be 80% certain that the limits of a 95%, two-sided interval included the difference. "Aire" indicates cuff to be filled with air. 5, pp. Secondly, this method is still provider-dependent as they decide when plunger drawback has ceased. At the study hospital, there are more females undergoing elective surgery under general anesthesia compared with males. These cookies do not store any personal information. supported this recommendation [18]. Thus, appropriate inflation of endotracheal tube cuff is obviously important. Curiel Garcia JA, Guerrero-Romero F, Rodriguez-Moran M: [Cuff pressure in endotracheal intubation: should it be routinely measured?]. 33. Dullenkopf A, Gerber A, Weiss M: Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. All data were double entered into EpiData version 3.1 software (The EpiData Association, Odense, Denmark), with range, consistency, and validation checks embedded to aid data cleaning. This is the routine practice in all three hospitals. Used by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. Part of 1993, 104: 639-640. Figure 2. Currently, in critical care settings, patients are intubated with ETT comprising high-volume low-pressure cuffs. For the secondary outcome, incidence of complaints was calculated for those with cuff pressures from 20 to 30cmH2O range and those from 31 to 40cmH2O. The compliance of the tube was determined from the measured cuff pressure (cmH2O) and the volume of air (ml) retrieved at complete deflation of the cuff; this showed a linear pressure-volume relationship: Pressure= 7.5. ETT cuff pressure estimation by the PBP and LOR methods. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. Also to note, most cuffs in the PBP group were inflated to a pressure that exceeded the recommended range in the PBP group, and 51% of the cuff pressures attained had to be adjusted compared with only 12% in the LOR group (Table 2). Adequacy of cuff inflation is conventionally determined by palpation of the external balloon. This cookie is used to a profile based on user's interest and display personalized ads to the users. In case of a very low pressure reading (below 20cmH, https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. Springer Nature. Every patient was wheeled into the operating theater and transferred to the operating table. The optimal technique for establishing and maintaining safe cuff pressures (2030cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Sao Paulo Med J. There was no correlation between the measured cuff pressure and the age, sex, height, or weight of the patients. protects the lung from contamination from gastric contents and nasopharyngeal matter such as blood. A total of 178 patients were enrolled from August 2014 to February 2015 with an equal distribution between arms as shown in the CONSORT diagram in Figure 1. If using an adult trach, draw 10 mL air into syringe. volume4, Articlenumber:8 (2004) One hundred seventy-eight patients were analyzed. 28, no. The pressure reading of the VBM was recorded by the research assistant. 2006;24(2):139143. The cookies collect this data and are reported anonymously. M. H. Bennett, P. R. Isert, and R. G. Cumming, Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuffa randomized controlled trial, Anesthesia and Analgesia, vol. The Data Safety Management Board (DSMB) comprised an anesthesiologist, a statistician, and a member of the SOMREC IRB who would be informed of any adverse event. Intensive Care Med. The cookie is a session cookies and is deleted when all the browser windows are closed. For example, Braz et al. Alternatively, cheaper, reproducible methods, like the minimum leak test that limit overly high cuff pressures should be sought and evaluated. Standard cuff pressure is 25mmH20 measured with a manometer. 6422, pp. Although this was a single-blinded, single-centre study, results suggest that the LOR syringe method was superior to PBP at administering pressures in the optimal range. The distribution of cuff pressures achieved by the different levels of providers. The study groups were similar in relation to sex, age, and ETT size (Table 1). On the other hand, overinflation may cause catastrophic complications. Surg Gynecol Obstet. 70, no. By clicking Accept, you consent to the use of all cookies. 720725, 1985. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat]. It is also likely that cuff inflation practices differ among providers. The study was approved by Makerere University College of Health Sciences, School of Medicine Research Ethics Committee (SOMREC), The Secretariat Makerere University College of Health Sciences, Clinical Research Building, Research Co-ordination Office, P.O. 18, no. stroke. If the silicone cuff is overinflated air will diffuse out. The cookie is set by Google Analytics and is deleted when the user closes the browser. 10, pp. However, a major air leak persisted. Tube positioning within patient can be verified. 443447, 2003. At the University of Louisville Hospital, at least 10 patients were evaluated with each endotracheal tube size (7, 7.5, 8, or 8.5 mm inner diameter [Intermediate Hi-Lo Tracheal Tube, Mallinckrodt, St. Louis, MO]); at Jewish Hospital, at least 10 patients each were evaluated with size 7, 7.5, and 8 mm Mallinckrodt Intermediate Hi-Lo Tracheal Tubes; and at Norton Hospital, 10 patients each were evaluated with size 7 and 8-mm Mallinckrodt Intermediate Hi-Lo Tracheal Tubes. Does that cuff on the trach tube get inflated with air or water? Analytics cookies help us understand how our visitors interact with the website. Informed consent was sought from all participants. 6, pp. 4, pp. chest pain or heart failure. 6, pp. How much air is injected into the cuff is not a major concern for almost all anaesthetists and they usually depend on palpating the external cuff tense to judge is it too much, accurate or not enough? Outcomes Research Institute, University of Louisville, 501 E. Broadway, Suite 210, Louisville, KY, 40202, USA, Papiya Sengupta,Daniel I Sessler&Anupama Wadhwa, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 S. Jackson St. University Hospital, Louisville, KY, 40202, USA, Daniel I Sessler,Paul Maglinger,Jaleel Durrani&Anupama Wadhwa, School of Medicine, University of Louisville School of Medicine, Louisville, KY, 40292, USA, You can also search for this author in Copyright 2017 Fred Bulamba et al. Numbers 110 were labeled LOR, and numbers 1120 were labeled PBP. Our secondary objective was to determine the incidence of postextubation airway complaints in patients who had cuff pressures adjusted to 2030cmH2O range or 3140cmH2O range. C) Pressure gauge attached to pilot balloon of normal cuff reading 30 mmHg with cuff inflated. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. 2013 Aug;117(2):428-34. doi: 10.1213/ANE.0b013e318292ee21. statement and None of the authors have conflicts of interest relating to the publication of this paper. - 10 mL syringe. . Christina M. Brown, MD, Resident, Department of Anesthesiology, Washington University in St. Louis, MO. Article Inject 0.5 cc of air at a time until air cannot be felt or heard escaping from the nose or mouth (usually 5 to 8 cc). What is the device measurements acceptable range? . 2017;44 408413, 2000. A syringe attached to the third limb of the stopcock was then used to completely deflate the cuff, and the volume of air removed was recorded. Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. This adds to the growing evidence to support the use of the LOR syringe for ETT cuff pressure estimation. Part 1: anaesthesia, British Journal of Anaesthesia, vol. This however was not statistically significant ( value 0.052). S. Stewart, J. Anesth Analg. Gac Med Mex. JD conceived of the study and participated in its design. The cookie is created when the JavaScript library executes and there are no existing __utma cookies. Distractions in the Operating Room: An Anesthesia Professionals Liability? Previous studies suggest that the cuff pressure is usually under-estimated by manual palpation. J. Liu, X. Zhang, W. Gong et al., Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study, Anesthesia and Analgesia, vol. This type of aneroid manometer is nearly as accurate as a mercury manometer, but easier to use [23]. Daniel I Sessler. P. Biro, B. Seifert, and T. Pasch, Complaints of sore throat after tracheal intubation: a prospective evaluation, European Journal of Anaesthesiology, vol. How do you measure cuff pressure? It is thus essential to maintain cuff pressures in the range of 2030 cm of H2O. This is used to present users with ads that are relevant to them according to the user profile. Support breathing in certain illnesses, such . 139143, 2006. 106, no. 6, pp. However, a full hour was plenty of time for the provider to have checked and adjusted cuff pressure to a suitable level. We observed a linear relationship between the measured cuff pressure and the volume of air retrieved from the cuff. 87, no. 1993, 42: 232-237. 4, pp. But opting out of some of these cookies may have an effect on your browsing experience. After screening, participants were allocated to either the PBP or the LOR group using block randomization, achieving a 1:1 allocation ratio. General anesthesia was induced by intravenous bolus of induction agents, and paralysis was achieved with succinylcholine or a non-depolarizing muscle relaxant. 8184, 2015. The size of ETT (POLYMED Medicure, India) was selected by the anesthesia care provider. H. M. Kim, J. K. No, Y. S. Cho, and H. J. Kim, Application of a loss of resistance syringe for obtaining the adequate cuff pressures of endotracheal intubated patients in an emergency department, Journal of the Korean Society of Emergency Medicine, vol. However, the performance of the air filled tracheal tube cuff at altitude has not been studied in vivo. There is consensus that keeping ETT cuff pressures low decreases the incidence of postextubation airway complaints [11]. In our study, 66.3% of ETT cuff pressures estimated by the LOR syringe method were in the optimal range. ismanagement of endotracheal (ET) tube cuff pressure (CP), defined as a CP that falls outside the recommended range of 20 to 30 cm H 2 O, is a frequent occur-rence during general anesthetics, with study findings ranging from 55% to 80%.1-4 Endotra-cheal tube cuffs are typically filled with air to a safe and adequate pressure of 20 to 30 cm H 2 Printed pilot balloon. The anesthesia providers were either physician anesthetists (anesthesiologists or residents) or nonphysicians (anesthetic officer or anesthetic officer student). N. Suzuki, K. Kooguchi, T. Mizobe, M. Hirose, Y. Takano, and Y. Tanaka, Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator, Masui, vol. In the later years, however, they can administer anesthesia either independently or under remote supervision. This cookie is set by Youtube and registers a unique ID for tracking users based on their geographical location. L. Gilliland, H. Perrie, and J. Scribante, Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg Academic Hospitals, Southern African Journal of Anaesthesia and Analgesia, vol. If more than 5 ml of air is necessary to inflate the cuff, this is an . Although the ETT pilot balloon was noted to be appropriately tense to the touch, a small amount of air was added to the cuff. Because nitrous oxide was not used, it is unlikely that the cuff pressures varied much during the first hour of the study cases. 175183, 2010. It is used to either assist with breathing during surgery or support breathing in people with lung disease, heart failure, chest trauma, or an airway obstruction. 1990, 44: 149-156. Cuff pressures less than 20cmH2O have been shown to predispose to aspiration which is still a major cause of morbidity, mortality, length of stay, and cost of hospital care as revealed by the NAP4 UK study. There were no statistically significant differences in measured cuff pressures among these three practitioner groups (P = 0.847). Tobin MJ, Grenvik A: Nosocomial lung infection and its diagnosis. Retrieved from. 345, pp. The poster can be accessed by following the link: https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. Figure 1. The distribution of cuff pressures (unadjusted) achieved by the different care providers is shown in Figure 2. H. Jin, G. Y. Tae, K. K. Won, J. There is a relatively small risk of getting ETT cuff pressures less than 30cmH2O with the use of the LOR syringe method [23, 24], 12.4% from the current study. The cookie is used to store and identify a users' unique session ID for the purpose of managing user session on the website. After induction of anesthesia, a 71-year-old female patient undergoing a parotidectomy was nasally intubated with a TaperGuard 6.5 Nasal RAE tube using a C-MAC KARL STORZ GmbH & Co. KG Mittelstrae 8, 78532 Tuttlingen, Germany, video-laryngoscope. The cuff was then progressively inflated by injecting air in 0.5-ml increments until a cuff pressure of 20 cmH2O was achieved. Airway 'protection' refers to preventing the lower airway, i.e. Our results are consistent in that measured cuff pressure exceeded 30 cmH2O in 50% of patients and were less than 20 cmH2O in 23% of patients. Listen for the presence of an air leak around the cuff during a positive pressure breath. Crit Care Med. This cookie is used by the WPForms WordPress plugin. Terms and Conditions, 617631, 2011. All authors read and approved the final manuscript. We recommend that ET cuff pressure be set and monitored with a manometer. 2001, 55: 273-278. El-Orbany M, Salem MR. Endotracheal tube cuff leaks: causes, consequences, and management. 2003, 38: 59-61. 3, pp. However, less serious complications like dysphagia, hoarseness, and sore throat are more prevalent [911]. The amount of air necessary will vary depending on the diameter of the tracheostomy tube and the patient's trachea. A wide-bore intravenous cannula (16- or 18-G) was placed for administration of drugs and fluids. allows one to provide positive pressure ventilation. With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Pressure was recorded at end-expiration after ensuring that the patient was paralyzed. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. In our case, had the endotracheal tube been checked prior to the start of the case, the defect could have been easily identified which would have obviated the need for tube exchange. 7, no. An endotracheal tube : provides a passage for gases to flow between a patients lungs and an anaesthesia breathing system . Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J: Sore throat after endotracheal intubation. Below are the links to the authors original submitted files for images. Braz JR, Navarro LH, Takata IH, Nascimento Junior P: Endotracheal tube cuff pressure: need for precise measurement. Bouvier JR: Measuring tracheal tube cuff pressures--tool and technique. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. 1990, 18: 1423-1426. CAS The difference in the incidence of sore throat and dysphonia was statistically significant, while that for cough and dysphagia was not. We also use third-party cookies that help us analyze and understand how you use this website. 1). Lien TC, Wang JH: [Incidence of pulmonary aspiration with different kinds of artificial airways]. Patients who were intubated with sizes other than these were excluded from the study. If using a neonatal or pediatric trach, draw 5 ml air into syringe. adequately inflate cuff . It does not store any personal data. Incidence of postextubation airway complaints in the study population. On the other hand, Nordin et al. However, complications have been associated with insufficient cuff inflation. U. Nordin, The trachea and cuff-induced tracheal injury: an experimental study on causative factors and prevention, Acta Oto-Laryngologica, vol. 4, pp. In this case, an air leak was audible from the patients oropharynx, which led the team to identify the problem quickly. Air sampling is an insensitive means of detecting Legionella pneumophila, and is of limited practical value in environmental sampling for this pathogen. Catastrophic consequences of endotracheal tube cuff over-inflation such as rupture of the trachea [46], tracheo-carotid artery erosion [7], and tracheal innominate artery fistulas are rare now that low-pressure, high-volume cuffs are used routinely.