Do lower cuff pressures reduce damage to the tracheal mucosa? A scanning electron microscopy study in neonatal pigs
| Autor: | Nelly Spielmann, Jacqueline Mauch, Urs Ziegler, Annette P N Kutter, Regula Bettschart-Wolfensberger, Sonja Hartnack, Anne Greet Bittermann, Markus Weiss |
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| Rok vydání: | 2012 |
| Předmět: |
Methyl Ethers
Manometry Swine medicine.medical_treatment Sevoflurane Tracheal mucosa Respiration Intubation Intratracheal medicine Animals Intubation Cilia Scanning electron microscopy study Air Pressure Mucous Membrane Inhalation business.industry respiratory system Respiration Artificial Trachea Anesthesiology and Pain Medicine Animals Newborn Anesthesia Anesthetics Inhalation Pediatrics Perinatology and Child Health Cuff Linear Models Microscopy Electron Scanning Anesthesia Inhalation Airway business medicine.drug |
| Zdroj: | Pediatric Anesthesia. 23:117-121 |
| ISSN: | 1155-5645 |
| DOI: | 10.1111/pan.12066 |
| Popis: | BACKGROUND: Modern high volume-low pressure (HVLP) endotracheal tubes (ETT) cuffs can seal the trachea using baseline cuff pressures (CP) lower than peak inspiratory airway pressures (PIP). The aim of the study was to determine whether this technique reduces the damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O. METHODS: Eighteen piglets were intubated with an ID 4.0 mm HVLP cuffed ETT (Microcuff PET) and artificially ventilated with 20 cmH(2) O PIP and 5 cmH(2) O PEEP. Animals were randomly allocated to two groups of CP: group A (just seal; n = 9) and group B (20 cmH(2) O; n = 9), controlled constantly with a manometer during the following 4-h study period under sevoflurane anesthesia. After euthanasia, cuff position was marked in situ. Damage in the cuff region was evaluated with scanning electron microscopy (SEM) examination by grading of mucosal damage and by estimating percentage of intact mucosal area both by a blinded observer. RESULTS: Maximal CP to seal the trachea in group A ranged from 12 to 18 cmH(2) O (median: 14 cmH(2) O). Using a mixed effects model approach, the estimated mean effect of group B vs group A was an increase of 17.9% (SE 8.1%) higher proportion of pictures with an area of at least 5% intact mucosa (P = 0.042). CONCLUSION: Minimal sealing pressures with cyclic pressure changes from CP did not result in decreased damage to the tracheal mucosa compared to constant CP of 20 cmH(2) O in this short-term animal trial. |
| Databáze: | OpenAIRE |
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