Keller, Christian, Brimacombe, Joseph, Boehler, Michael, Loeckinger, Alexander, and Puehringer, Friedrich (2002) The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube. Anesthesiology, 96 (5). pp. 1074-1077.

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Abstract

Background: The authors determined the influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures for the esophageal tracheal combitube.

Methods: Twenty fresh cadavers were studied. Microchip sensors were attached to the anterior, lateral, and posterior surfaces of the distal and proximal cuffs of the small adult esophageal tracheal combitube. Mucosal pressure for the proximal cuff in the pharynx was measured at 0- to 100-ml cuff volume in 10-ml increments, and for the distal cuff in the esophagus and trachea were measured at 0- to 20-ml cuff volume in 2-ml increments. The proximal cuff volume to form an oropharyngeal seal of 30 cm H₂O was determined. In addition, mucosal pressures for the proximal cuff in the pharynx were measured in four awake volunteers with topical anesthesia.

Results: There was an increase in mucosal pressure in the trachea, esophagus, and pharynx at all cuff locations with increasing volume (all:P < 0.001). Pharyngeal mucosal pressures were highest posteriorly (50-ml cuff volume: 99 ± 62 cm H₂O; 100-ml cuff volume: 255 ± 161 cm H₂O). Esophageal mucosal pressures were highest posteriorly (10-ml cuff volume: 108 ± 55 cm H₂O; 20-ml cuff volume: 269 ± 133 cm H₂O). Tracheal mucosal pressures were highest anteriorly (10-ml cuff volume: 98 ± 53 cm H₂O; 20-ml cuff volume: 236 ± 139 cm H₂O). The proximal cuff volume to obtain an oropharyngeal seal of 30 cm H₂O was 47 ± 12 ml. Pharyngeal mucosal pressures were similar for cadavers and awake volunteers.

Conclusion: We conclude that mucosal pressures for the esophageal tracheal combitube increase with cuff volume, are highest where the cuff is adjacent to rigid anatomic structures, and potentially exceed mucosal perfusion pressure even when cuff volumes are limited to achieving an oropharyngeal seal of 30 cm H₂O.

Item ID:	27198
Item Type:	Article (Research - C1)
ISSN:	1528-1175
Keywords:	cuff volume, pharyngeal, esophageal, tracheal
Date Deposited:	24 May 2013 06:50
FoR Codes:	11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110301 Anaesthesiology @ 100%
SEO Codes:	92 HEALTH > 9299 Other Health > 929999 Health not elsewhere classified @ 100%
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