Use of pressure volume loop closure to check for endotracheal tube cuff function. Randomized clinical trial

OBJECTIVE: To assess the efficacy of pressure volume loop (PV-L) closure as an indicator of adequate endotracheal tube cuff (ETTc) function, and to compare this with commonly used methods of checking cuff pressure.

METHODS: We conducted a randomized clinical trial at the Department of Anesthesia, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia from October 2011 to February 2012. One hundred and forty patients were intubated, and the ETTc was inflated using one of 3 techniques. The intubating anesthesiologist inflated the cuff at his discretion until he detected no further air leak in the first technique. In the second technique, we maintained the ETTc pressure at 20 centimeter water, while the third technique used PV-L closure.

RESULTS: The PV-L technique required lower amounts of air to inflate the ETTc than the other 2 techniques (3.89+/-0.26 for PV-L versus 4.4+/-0.36 for fixed preset pressure, and 5.26+/-0.46 for pilot balloon palpation, p=0.00001) and the mean cuff pressure was lower than other techniques (18.67+/-0.72 for PV-L versus 20 for fixed preset pressure, and 33.48+/-3.49 for pilot balloon palpation, p=0.00001).

CONCLUSION: The PV-L closure technique is an alternative way to check for ETTc function with a significantly lower ETTc pressure and volume than those recorded with a manually inflated cuff, or with preset cuff pressure of 20 cmH2O.