International Journal of Engineering and Manufacturing (IJEM)
IJEM Vol. 1, No. 4, 29 Aug. 2011
Cover page and Table of Contents: PDF (size: 122KB)
Sensitivity Training of Residents to Pressure Improves the Management of Tracheal Tube Intracuff Pressure
Full Text (PDF, 122KB), PP.53-58
Views: 0 Downloads: 0
Author(s)
You Zhi-jian
1,*
Xu Hong-xia
1
Wang Xue-mei
2
Index Terms
Incubation, intracuff pressure, pressure control ventilation, resident, tracheal tube
Abstract
Insufficient cuff pressure of tracheal tube (TT) increases the risk of secretions aspiration and consequent pulmonary infection, whereas high pressure may cause tracheal injury. It is very important to control cuff pressure at the optimal status for air care providers. Volume control ventilation (VCV) is often applied to verify the cuff pressure. We used different volumes of syringe as simulated trachea, selected Proterx 7.0 tube to do the intubation, and recorded the volume of air ventilated and the corresponding intracuff pressure. The result indicated that pressures increased intensively when air volumes surpassed certain values, which suggested VCV method was not appropriate to control the intracuff pressure, and pressure control ventilation might be the better choice. In that case, air care providers have to improve their ability to control pressure. Herein, we enrolled 80 residents into sensitivity training for pressure. Trainees were required to palpate the pilot balloons of 12 tubes (Portex7.0) with different intracuff pressure repeatedly to sense the pressure, 1 hour/ day for 3 days. Trainees who could arrange tubes in turn and control the intracuff pressure at optimal range (20-30cm H2O) during intubation in model were considered eligible, the rest were trained continuously till eligible. Inappropriate percent －The proportion of residents who could not control intracuff pressure appropriately － were recorded before training, after training, one month, three months and six months after training. The results indicated that the training method was effective to improve the ability of residents to control the intracuff pressure, the inappropriate percent increased gradually over time, the average intracuff pressure surpassed the optimal value at six months post-training, suggesting six months should be time point for retraining.
Cite This Paper
You Zhi-jian,Xu Hong-xia,Wang Xue-mei,"Sensitivity Training of Residents to Pressure Improves the Management of Tracheal Tube Intracuff Pressure", IJEM, vol.1, no.4, pp.53-58, 2011. DOI: 10.5815/ijem.2011.04.08
Reference
[1]Harris R, Joseph A. Acute tracheal rupture related to endotracheal intubation: case report. J Emerg Med 2000; 18: 35-9.
[2]Moschini V, Losappio S, Dabrowska D, Lorno V. Tracheal rupture after tracheal intubation: effectiveness of conservation treatment. Minerva Anestesiol 2006; 72 (12): 1007-12.
[3]Friis J, Turner A, Da Fonseca J. Overinflated tracheal tube cuff. Emerg Med J 2009; 26(3):182.
[4]Wain JC Jr. Postintubation tracheal stenosis. Semin Thorac Cardiovasc Surg 2009; 21 (3): 284-9.
[5]Harneed AA, Moharned H, AI-Mansoori M. Acquired tracheosophageal fistula due to high intracuff pressure. Ann Thora Med 2008; 3(1): 23-5.
[6]Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am 2003; 13 (2): 271-89.
[7]Sanada Y, Kojima Y, Fonkalsrud EW. Injury of cilia induced by tracheal tube cuffs. Surg Gynecol Obstet 1982; 154(5): 648-52.
[8]Stewart SL, Secrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J 2003; 71: 443-7.
[9]Duguet A, D’Amico L, Biondi G, Prodanovic H, Gonzalez-Bermejo J, Similowski T. Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med 2007; 33 (1): 28-32.
[10]Chan SM, Wong CS, Cherng CH. Determing an optimal tracheal tube cuff pressure by the feel of the pilot balloon: a training course for trainees providing airway care. Acta Anaesthesiol Taiwan 2009; 47 (2): 79-83.
[11]Abdelatti MO. A cuff pressure controller for tracheal tubes and laryngeal mask airways. Anaesthesia 1999; 54: 981-6.
[12]Farre R, Rotger M, Ferre M, Torres A, Navajas D. Automatic regulation of the cuff pressure in endotracheally-intubated patients. Eur Respir J 2002; 20:1010-3.
[13]Kunitz O, Jansen R, Ohnsorge E, Haaf-vonBelow S, Schulz-Stübner S, Rossaint R. Cuff pressure monitoring and regulation in adults. Anaesthesist 2004; 53: 334-40.
[14]Weiss M, Doell C, Koepfer N, Madjdpour C, Woitzek K, Bernet V. Rapid pressure compensation by automated cuff pressure controllers worsens sealing in tracheal tubes. Br J Anaesth 2009; 102 (2): 273-8.
[15]Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med 2006; 24(2): 139-43.