Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

BMC Musculoskeletal Disorders

Bas A in’t Veld¹  Jasper F C Wolfs²  Jessica de Vries¹  Thijs C D Rettig¹  Mark P Arts² 

[1] Department of Anesthesiology, Medical Center Haaglanden, The Hague, The Netherlands;Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands

关键词: Dysphagia;    Hoarseness;    Sore throat;    Endotracheal tube cuff pressure;    Surgical retractor;    Anterior cervical spine surgery;   

Others  :  1129544
DOI  :  10.1186/1471-2474-14-280

 received in 2013-01-27, accepted in 2013-09-18,  发布年份 2013

【 摘 要 】

Background

In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia.

Methods/design

177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months.

Discussion

Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial.

Trial registration

Netherlands Trial Register (NTR) 3542: http://www.trialregister.nl webcite.

【 授权许可】

   
2013 Arts et al.; licensee BioMed Central Ltd.

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