The effect of adjusting tracheal tube cuff pressure during deep hypothermic circulatory arrest A randomised trial
Abstrakt
BACKGROUND Regular endotracheal tube cuff monitoring may prevent silent aspiration. OBJECTIVES We hypothesised that active management of the cuff of the tracheal tube during deep hypothermic cardiac arrest would reduce silent subglottic aspiration.
We also determined to study its effect on postoperative mechanical ventilation and the incidence of postoperative positive tracheal cultures. DESIGN A randomised clinical trial.
SETTING The study was conducted in a University Teaching Hospital from September 2008 to November 2009. PATIENTS Twenty-four patients undergoing elective pulmonary endarterectomy were included in the study.
MAIN OUTCOME MEASURES The primary aim of this study was to determine the incidence of silent aspiration. Secondary outcomes included duration of postoperative mechanical ventilation of the lungs and incidence of positive culture of tracheal aspirate.
RESULTS Active cuff management patients were younger than controls (51.2 +/- 11.6 vs. 63.2 +/- 9 years, P = 0.028), but otherwise the two groups were similar. The primary endpoint was reached because we showed that silent aspiration was significantly less frequent in the study group (0/12 vs. 8/12 patients, P = 0.001).
Significantly lower intracuff pressures were measured in the control group patients at several timepoints during cooling, just before hypothermic arrest and at all timepoints during rewarming. CONCLUSION We recommend that the cuff of the tracheal tube should be checked regularly during surgery under deep hypothermia, and the cuff pressure adjusted as required.