RT Journal Article
SR Electronic
T1 Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management
JF Respiratory Care
FD American Association for Respiratory Care
SP 2039
OP 2044
DO 10.4187/respcare.01812
VO 57
IS 12
A1 Bolzan, Douglas Willian
A1 Gomes, Walter Jose
A1 Faresin, Sônia Maria
A1 de Camargo Carvalho, Antônio Carlos
A1 De Paola, Ângelo Amato Vincenzo
A1 Guizilini, Solange
YR 2012
UL http://rc.rcjournal.com/content/57/12/2039.abstract
AB BACKGROUND: Despite numerous studies on endotracheal tube cuff pressure (CP) management, the literature has yet to establish a technique capable of adequately filling the cuff with an appropriate volume of air while generating low CP in a less subjective way. The purpose of this prospective study was to evaluate and compare the CP levels and air volume required to fill the endotracheal tubes cuff using 2 different techniques (volume-time curve versus minimal occlusive volume) in the immediate postoperative period after coronary artery bypass grafting. METHODS: A total of 267 subjects were analyzed. After the surgery, the lungs were ventilated using pressure controlled continuous mandatory ventilation, and the same ventilatory parameters were adjusted. Upon arrival in the ICU, the cuff was completely deflated and re-inflated, and at this point the volume of air to fill the cuff was adjusted using one of 2 randomly selected techniques: volume-time curve and minimal occlusive volume. We measured the volume of air injected into the cuff, the CP, and the expired tidal volume of the mechanical ventilation after the application of each technique. RESULTS: The volume-time curve technique demonstrated a significantly lower CP and a lower volume of air injected into the cuff, compared to the minimal occlusive volume technique (P < .001). No significant difference was observed in the expired tidal volume between the 2 techniques (P = .052). However, when the subjects were submitted to the minimal occlusive volume technique, 17% (n = 47) experienced air leakage as observed by the volume-time graph. CONCLUSIONS: The volume-time curve technique was associated with a lower CP and a lower volume of air injected into the cuff, when compared to the minimal occlusive volume technique in the immediate postoperative period after coronary artery bypass grafting. Therefore, the volume-time curve may be a more reliable alternative for endotracheal tube cuff management.