The Clinical Need [1]
Mechanical ventilation and intubation of patients for longer than 48 hours puts the patient at risk of complications. Over-inflation of the cuff may result in injury of the trachea or the vocal cords, while under-inflation may result in aspiration of contaminated subglottic secretions into the lungs, which may cause Ventilator-Associated Pneumonia (VAP).
Those complications render the respiration procedure complex and costly, and may result in prolonged hospitalization and high mortality rates. [2] [3] [4] [5]
The Risk of Aspiration
The Risk of Tracheal Tissue Injury
Correct and accurate inflation of the cuff is a crucial element in minimizing the complications of prolonged intubation, yet several tests show that medical staff finds it hard to inflate, maintain and estimate cuff pressure palpation.[6] [7]
The accurate management of cuff pressure is specifically crucial in Pediatrics, yet studies show that a significant percentage of pediatric patients have a cuff pressure greater than the generally recommended upper limit.[8] [9]
[1] Ramesh, Archana S. et al. An in vitro and in vivo validation of a novel monitor for intracuff pressure in cuffed endotracheal tubes.
[2] Lizy, Christelle et al. Cuff Pressure of Endotracheal Tubes After Changes in Body Position in Critically Ill Patients Treated With Mechanical Ventilation;
[3] Bhatti, Nasir I. et al. Cost analysis of intubation-related tracheal injury using a national database.
[4] Freebairn, Ross C. et al. Endotracheal Cuff Pressures in Ventilated Patients in Intensive Care.
[5] Kyaw, Moe H. et al. Healthcare utilization and costs associated with S. aureus and P. aeruginosa pneumonia in the intensive care unit: a retrospective observational cohort study in a US claims database (2015).
[6] Hoffman, Robert J. et al. Experienced Emergency Medicine Physicians Cannot Safely Inflate or Estimate Endotracheal Tube Cuff Pressure Using Standard Techniques.
[7] Bryant, Jason et al. Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon?
[8] Tobias, Joseph D. et al. Cuffed endotracheal tubes in infants and children: Should we routinely measure the cuff pressure?
[9] Schloss, Bryan et al. The laryngeal mask in infants and children: What is the cuff pressure?
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