Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting

Journal of Cardiothoracic Surgery

Walter J Gomes²  Angelo AV De Paola³  Antonio CC Carvalho³  Sonia M Faresin¹  Solange Guizilini⁴  Douglas W Bolzan³ 

[1] Department of Medicine, Pneumology Discipline, São Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Pedro de Toledo, 720, Sao Paulo, 04039-002, Brazil;Department of Medicine, Cardiovascular Surgery Discipline, Pirajussara and São Paulo Hospitals, Escola Paulista de Medicina, Federal University of Sao Paulo, Napoleao de Barros, 715, Sao Paulo, 04024-002, Brazil;Department of Medicine, Cardiology Discipline, Pirajussara and São Paulo Hospitals, Escola Paulista de Medicina, Federal University of Sao Paulo, Napoleao de Barros, 715, Sao Paulo, 04024-002, Brazil;Cardiology Discipline, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Napoleao de Barros, 715, 04024-002, Sao Paulo, Brazil

关键词: Mechanical ventilation;    Expired tidal volume;    Air leakage;    Endotracheal tube cuff pressure;    Coronary artery bypass grafting;   

Others  :  1153180
DOI  :  10.1186/1749-8090-7-53

 received in 2012-02-18, accepted in 2012-06-10,  发布年份 2012

【 摘 要 】

Background

Previous investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself. However is not established in literature if this loss of CP is able to generate alterations on expired tidal volume (ETV). Therefore, the aim of this study was to evaluate the potential consequences of the endotracheal CP assessment maneuver on CP levels and ETV in the early postoperative of coronary artery bypass grafting (CABG).

Methods

A total of 488 patients were analyzed. After the operation, the lungs were ventilated in pressure-assist-control mode and the same ventilatory settings were adjusted for all patients. After intensive care unit arrival, the cuff was fully deflated and then progressively inflated by air injection, to promote a minimal volume to occlude the trachea. To assist the cuff inflation and the air leakage identification, the graphical monitoring of the volume-time curve was adopted. After 20 minutes a first cuff pressure evaluation was performed (P1) and a second measurement (P2) was taken after 20 minutes with an analog manometer. ETV was obtained always pre and post P1 measurement.

Results

The CP assessment maneuver promoted a significant drop of P2 in relation to P1 when the manometer was attached to the pilot balloon (p < 0.0001). When compared the moments, pre-P1 versus post-P1, a significant drop of the ETV was also observed (p < 0.0001).

Conclusion

The CP assessment maneuver promoted a significant decrease in CP values and occurrence of air leakage with reduction of ETV in the early postoperative of CABG.

【 授权许可】

   
2012 Bolzan et al.; licensee BioMed Central Ltd.

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