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Research Paper | Medical Science | India | Volume 13 Issue 11, November 2024 | Popularity: 4.8 / 10

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Endotracheal Tube Cuff Pressure Changes in Mechanically Ventilated Patients Undergoing General Anaesthesia with O2, N2o & Other Inhalation Agents in Elective O. T. & in Intensive Care Unit Set-Up with O2 and Air - A Prospective Observational Study

Dr. Nilotpal Das, Dr Mrinal Kanti Taye, Dr. Babita Lahkar, Dr. Putul Pegu

Abstract: Laryngotracheal morbidity is frequent with tracheal intubation under general anesthesia. Excessive endotracheal tube cuff pressure may impair the tracheal mucosal perfusion and can cause tracheal damage. With recent advances, monitoring the cuff pressure and adjusting the cuff pressure to an acceptable level, the intraoperative and post-extubation morbidity can be minimized in patients undergoing surgeries under general anesthesia and mechanically ventilated patients in ICU as well. Aim: To observe endotracheal tube cuff pressure, change in Mechanically ventilated patients undergoing General Anaesthesia with O2, N2O & others inhalation agents in elective O. T. & in ICU set-up with O2 and air. Objectives: 1) The volume of air required to produce appropriate cuff pressure. 2) To confirm the changes in the cuff pressure by using cuff pressure manometer. 3) To study the effect of different position on cuff pressure (GA with supine & prone; Mechanically ventilated in ICU with supine & propped up position.) 4) To study the effect of different sizes of ETT on cuff pressure. 5) Any post-extubation related morbidity. Inclusion Criteria: 1) Age group of 18 to 60 years of both gender 2) Surgery under General Anaesthesia with O2, N2O & other inhalation agents in Elective O. T & duration of Surgery more than 1 hr. 3) Patients intubated in ICU with O2 & Air and Mechanically ventilated for more than 1hr. Exclusion Criteria: 1) Contra Indication to the use of nitrous oxide in OT-group. 2) Surgery and mechanically ventilated patients in ICU less than one hr. Material and Methods: This is a prospective observational study conducted after obtaining approval from the institutional ethical committee, at Fakhruddin Ali Ahmed Medical College And Hospital, in 100 patients of age 18-60 years undergoing elective surgeries under GA and mechanically ventilated patients in ICU. We conducted this study in fifty patients in each group [OT Group and ICU Group] who were eligible for the study criteria and underwent Intubation & MV in GA and MV patients in ICU. The Portex cuff pressure manometer has been used to monitored ETT cuff pressures. OT Group: 50 patients who underwent surgery under GA, were considered. Standard induction and maintenance for general anaesthesia was followed as per Hospital protocol. Cuff pressure was measured immediately after intubation following inflation with predetermined volume of air & adjust the cuff pressure to an acceptable level of mean mucosal perfusion pressure using Portex cuff pressure manometer. The volume of air withdrawn from endotracheal tube cuff to maintain therapeutic cuff pressure range were noted. Subsequent measurement was taken every 30 mins interval & last reading just before deflate the endotracheal tube cuff for extubation. Therefore, the association between the volume of air removed and cuff pressure was studied. ICU Group: 50 patients who were eligible for this study, underwent intubation & MV in ICU. Similarly, ETT cuff pressures were measured immediately after intubation. Volume of air removed as necessary to adjust cuff pressure to an acceptable level of mean mucosal perfusion pressure and noted. Subsequent reading was taken every 30mins, 1hr, 1.30 hrs and so on. This group were followed for next 24 hrs for any rise in cuff pressure using Portex manometer.

Keywords: tracheal intubation, cuff pressure monitoring, general anaesthesia, mechanically ventilated patients, post-extubation morbidity

Edition: Volume 13 Issue 11, November 2024

Pages: 977 - 981

DOI: https://www.doi.org/10.21275/MR241116200650

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