Volume-Time Curve: An Alternative for Endotracheal Tube Cuff Management


Autoria(s): Bolzan, Douglas Willian; Gomes, Walter José; Faresin, Sonia Maria; Carvalho, Antonio Carlos de Camargo; Paola, Angelo Amato Vincenzo de; Guizilini, Solange
Contribuinte(s)

Universidade Federal de São Paulo (UNIFESP)

Pirajussara Hosp

São Paulo Hosp

Data(s)

24/01/2016

24/01/2016

01/12/2012

Resumo

BACKGROUND: Despite numerous studies on endotracheal tube cuff pressure (CP) management, the literature has yet to establish a technique capable of adequately tilling 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.

Universidade Federal de São Paulo, Div Cardiol, Escola Paulista Med, BR-04024002 São Paulo, Brazil

Universidade Federal de São Paulo, Div Pneumol, Escola Paulista Med, BR-04024002 São Paulo, Brazil

Pirajussara Hosp, Cardiovasc Surg Discipline, São Paulo, Brazil

São Paulo Hosp, Cardiovasc Surg Discipline, São Paulo, Brazil

Universidade Federal de São Paulo, Phys Therapy Sch, Dept Human Movement Sci, BR-04024002 São Paulo, Brazil

Universidade Federal de São Paulo, Div Cardiol, Escola Paulista Med, BR-04024002 São Paulo, Brazil

Universidade Federal de São Paulo, Div Pneumol, Escola Paulista Med, BR-04024002 São Paulo, Brazil

Universidade Federal de São Paulo, Phys Therapy Sch, Dept Human Movement Sci, BR-04024002 São Paulo, Brazil

Web of Science

Formato

2039-2044

Identificador

http://dx.doi.org/10.4187/respcare.01812

Respiratory Care. Irving: Daedalus Enterprises Inc, v. 57, n. 12, p. 2039-2044, 2012.

0020-1324

http://repositorio.unifesp.br/handle/11600/35538

10.4187/respcare.01812

WOS:000312057300007

Idioma(s)

eng

Publicador

Daedalus Enterprises Inc

Relação

Respiratory Care

Direitos

Acesso aberto

Palavras-Chave #endotracheal tube cuff pressure #air leakage #volume-time curve #minimal occlusive volume technique #cuff pressure management #coronary artery bypass surgery
Tipo

Artigo