To the Editor,
We read the report by Miao et al.1 suggesting that a simple method is needed for monitoring endotracheal tube (ETT) cuff pressure and herein present such a method.
We use a conventional invasive blood pressure monitor transducer to continuously display the ETT cuff pressure on the anesthetic monitoring system (Figure). As anesthesiologists already focus on vital signs in daily practice, measuring the ETT cuff pressure would be an easy addition for the same monitoring. This would overcome the inconvenience of intermittently using a manual pressure gauge and if the pressure measurement were out of range, it would be easier to see and could have an alarm set to alert the anesthesiologist to the maximum and minimum cuff pressures. Ganigara et al. reported on continuous real-time ETT cuff pressure monitoring2 and correlations of pressure between the manometer and a standard invasive pressure monitoring device were assessed by Krishna et al.3 Pressure is displayed in mmHg, which should be converted to cmH2O (1 cmH2O ≈ 0.74 mmHg), and appropriate cuff pressures are between 20 and 30 cmH2O; these can be converted to 15-22 mmHg. The process adds minimal cost as the system can easily be re-used, and it limits the complications related to high cuff pressure.4
A) The pressure monitor transducer system that can be connected to the endotracheal cuff pilot balloon (no inflatable pressure bag is needed). B) Endotracheal cuff pressure (red arrow) can measure continuously and be displayed on the anesthetic monitor
This technique may be particularly useful for cervical spine and otolaryngologic surgeries when the ETT is too remote from the anesthesiologists and it is difficult to use manual hand-held manometers. Furthermore, in cervical spine and otolaryngologic surgeries, the trachea is frequently compressed, and many complications are reported.4 Pressure monitors are very necessary, but paradoxically, it is more difficult during these surgeries to monitor ETT cuff pressure.
We thus recommend that our colleagues use this simple, inexpensive monitor in daily practice.
References
Miao I, Jee R, Pysyk CL. Under pressure: an audit of airway device pressures. Can J Anesth 2018. DOI: https://doi.org/10.1007/s12630-018-1053-y.
Ganigara A, Ramavakoda C. Continuous real time endotracheal tube cuff pressure waveform. J Clin Monit Comput 2014; 28: 433-4.
Krishna S, Ramesh A, Jatana K, et al. A technique to measure the intracuff pressure continuously: an in vivo demonstration of its accuracy. Paediatr Anaesth 2014; 24: 999-1004.
Kako H, Goykhman A, Ramesh AS, Krishna SG, Tobias JD. Changes in intracuff pressure of a cuffed endotracheal tube during prolonged surgical procedures. Int J Pediatr Otorhinolaryngol 2015; 79: 76-9.
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This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.
Editor’s note
The authors of the article: Can J Anesth 2018; https://doi.org/10.1007/12630-018-1053-y, respectfully declined an invitation to submit a reply to the above letter.
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Kim, J.B., Lee, J.M. A simple and widely available alternative method for endotracheal tube cuff pressure monitoring. Can J Anesth/J Can Anesth 65, 956–957 (2018). https://doi.org/10.1007/s12630-018-1107-1
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DOI: https://doi.org/10.1007/s12630-018-1107-1