RESUMO
Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46.07±23.54 cmH2O in the fixed volume group and 33.72±9.14 cmH2O in the MLT group (P=0.05) which is significantly higher in the fixed volume group (P=0.028). In addition, 56.4% and 78.2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P=0.025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.
RESUMO
Introduction: Filling tracheal tube cuff (TTC) after intubation is necessary to provide a safe airway in intubated patients. On the other hand, excessive increase or decrease in the pressure of TTC's balloon leads into the dangerous complications such as necrosis and/or aspiration. Accordingly, in the present study, we tried to evaluate the most two common fixed volume and pilot balloon palpitation methods to control TTC pressure. Methods: In a prospective cross-sectional study that was carried out in the emergency department of Tabriz Imam Reza hospital upon 194 patients who needed intubation and from April 2015 to June 2016. The patients were randomly allocated into two equal groups. For the first the Pilot Balloon Palpation technique and for the second group 10 cc fixed volume cuff filling technique was assigned. After that, the pressure was checked with manometer and data were analyzed using SPSS software. Results: TTC pressure average in fixed volume group was 44.96±21.77 cmH2O and for palpation group, it was 118.15±22.15 cmH2O. There was a meaningful difference between two groups in terms of cuff inside pressure (P value <0.001) and it was meaningfully lower in fixed volume group than the first one. Conclusion: The present study showed that pilot balloon palpation or fixed volume method was not appropriate methods to assess cuff pressure during intubation and the cuff pressure must be controlled by the manometer.
RESUMO
INTRODUCTION: Unsuccessful tracheal intubation is considered the most common cause of anesthesia death or brain damage. This study delineates our experience recommending modifications in the cricothyroidotomy technique. METHODS: Thirty emergency medicine residents of participated in a study performed on the human simulator moulage in Skill Laboratory of Tabriz University of Medical Science. The cricothyroid membrane was punctured using a 16-gauge cannula. Later, J guide wire was advanced into trachea and standard 16-gauge intravenous cannula with a removable needle stylet withdrawn after the puncture being dilated by a dilator. Consequently, a cuffed tracheal tube (ID= 6) was introduced from the foramen. RESULTS: From 30 residents, 18 residents performed cricothyroidotomy within 1 minute, 7 residents in 2 minutes and 5 residents failed to fulfill the procedure. CONCLUSION: Several studies using cadavers and human simulators have demonstrated the pre-hospital feasibility of this technique. However, descriptions of clinical pre-hospital experience with percutaneous cricothyroidotomy are limited. This study shows that skill lab may help residents to acquire techniques required in management of difficult airway.
