Evaluation of the optimal cuff volume and cuff pressure of the revised laryngeal tube “LTS-D” in surgical patients
Identifieur interne : 000248 ( Main/Exploration ); précédent : 000247; suivant : 000249Evaluation of the optimal cuff volume and cuff pressure of the revised laryngeal tube “LTS-D” in surgical patients
Auteurs : Marc Kriege [Allemagne] ; Christian Alflen [Allemagne] ; Johannes Eisel [Allemagne] ; Thomas Ott [Allemagne] ; Tim Piepho [Allemagne] ; Ruediger R. Noppens [Allemagne]Source :
- BMC Anesthesiology [ 1471-2253 ] ; 2017.
Abstract
Recent case reports have indicated significant cuff overinflation when using the standard filling volume based on the manufacturer’s recommendations in older models of laryngeal tubes. The aim of this study was to determine the minimum cuff pressure needed to perform standardized ventilation without leakage in the new, revised model of the laryngeal tube “LTS-D”.
After ethical approval, LTS-D was placed for ventilation in 60 anesthetized patients. The cuff was inflated to the recommended volume (#3: 60 ml, #4: 80 ml, and #5: 90 ml). After evaluation of the initial cuff pressure (CP), the CP was lowered in 10 cmH2O steps until a minimal cuff pressure of 30 cmH2O was achieved. The absence of an audible leak was required for a step-by-step reduction in the CP. Evacuated cuff volume, success rate, and airway injuries were documented. Data were expressed as medians (interquartile ranges [IQRs]). The comparison of CPs and cuff volumes was performed using the Mann-Whitney test.
After initial inflation, the CP ranged from 105 cmH2O [90–120; #5] to 120 cmH2O [110–120; #3]. Lowering the CP to 60 cmH2O resulted in a reduced cuff volume ranging from 47 ml [44–54; #3] to 77 ml [75–82; #5] compared to the initial inflation (
We found significant overinflation of the revised LTS-D using the recommended volume for initial cuff inflation. A CP of 60 cmH2O was found to be sufficient for ventilation in the majority of patients evaluated. Checking and adjusting the CP in laryngeal tubes is mandatory to avoid overinflation.
ClinicalTrials.gov
The online version of this article (doi:10.1186/s12871-017-0308-4) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12871-017-0308-4
PubMed: 28152975
PubMed Central: 5290637
Affiliations:
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type="wicri:Area/Main/Exploration">000248</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Evaluation of the optimal cuff volume and cuff pressure of the revised laryngeal tube “LTS-D” in surgical patients</title><author><name sortKey="Kriege, Marc" sort="Kriege, Marc" uniqKey="Kriege M" first="Marc" last="Kriege">Marc Kriege</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical Center of the Johannes Gutenberg-University Mainz,</institution></institution-wrap>Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Mainz</wicri:regionArea></affiliation></author><author><name sortKey="Alflen, Christian" sort="Alflen, Christian" uniqKey="Alflen C" first="Christian" last="Alflen">Christian Alflen</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical Center of the Johannes Gutenberg-University Mainz,</institution></institution-wrap>Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Mainz</wicri:regionArea></affiliation></author><author><name sortKey="Eisel, Johannes" sort="Eisel, Johannes" uniqKey="Eisel J" first="Johannes" last="Eisel">Johannes Eisel</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical Center of the Johannes Gutenberg-University Mainz,</institution></institution-wrap>Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Mainz</wicri:regionArea></affiliation></author><author><name sortKey="Ott, Thomas" sort="Ott, Thomas" uniqKey="Ott T" first="Thomas" last="Ott">Thomas Ott</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical Center of the Johannes Gutenberg-University Mainz,</institution></institution-wrap>Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Mainz</wicri:regionArea></affiliation></author><author><name sortKey="Piepho, Tim" sort="Piepho, Tim" uniqKey="Piepho T" first="Tim" last="Piepho">Tim Piepho</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical 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Noppens</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410607.4</institution-id><institution>Department of Anesthesiology,</institution><institution>University Medical Center of the Johannes Gutenberg-University Mainz,</institution></institution-wrap>Mainz, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Mainz</wicri:regionArea></affiliation><affiliation><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8884</institution-id><institution-id institution-id-type="GRID">grid.39381.30</institution-id><institution>Department of Anesthesia & Perioperative Medicine,</institution><institution>Western University; LHSC- University Hospital,</institution></institution-wrap>339 Windermere Road, London, ON N6A 5A5 Canada</nlm:aff><wicri:noCountry code="subfield">ON N6A 5A5 Canada</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Anesthesiology</title><idno type="eISSN">1471-2253</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Recent case reports have indicated significant cuff overinflation when using the standard filling volume based on the manufacturer’s recommendations in older models of laryngeal tubes. The aim of this study was to determine the minimum cuff pressure needed to perform standardized ventilation without leakage in the new, revised model of the laryngeal tube “LTS-D”.</p></sec><sec><title>Methods</title><p>After ethical approval, LTS-D was placed for ventilation in 60 anesthetized patients. The cuff was inflated to the recommended volume (#3: 60 ml, #4: 80 ml, and #5: 90 ml). After evaluation of the initial cuff pressure (CP), the CP was lowered in 10 cmH<sub>2</sub>O steps until a minimal cuff pressure of 30 cmH<sub>2</sub>O was achieved. The absence of an audible leak was required for a step-by-step reduction in the CP. Evacuated cuff volume, success rate, and airway injuries were documented. Data were expressed as medians (interquartile ranges [IQRs]). The comparison of CPs and cuff volumes was performed using the Mann-Whitney test.</p></sec><sec><title>Results</title><p>After initial inflation, the CP ranged from 105 cmH<sub>2</sub>O [90–120; #5] to 120 cmH<sub>2</sub>O [110–120; #3]. Lowering the CP to 60 cmH<sub>2</sub>O resulted in a reduced cuff volume ranging from 47 ml [44–54; #3] to 77 ml [75–82; #5] compared to the initial inflation (<italic>p</italic> < 0.001). Leakage occurred more frequently when the CP was lowered to 40 cmH<sub>2</sub>O compared to the initial inflation (44/54 [81%]; <italic>p</italic> < 0.01). Using a CP between 50 cmH<sub>2</sub>O and 60 cmH<sub>2</sub>O, a leakage rate of 3/54 (5%) was observed, compared to a rate of 11/54 (21%) when using a CP lower than 50 cmH<sub>2</sub>O. The overall success rate was 90%, and airway injury occurred in 7% of patients (4/60).</p></sec><sec><title>Conclusion</title><p>We found significant overinflation of the revised LTS-D using the recommended volume for initial cuff inflation. A CP of 60 cmH<sub>2</sub>O was found to be sufficient for ventilation in the majority of patients evaluated. Checking and adjusting the CP in laryngeal tubes is mandatory to avoid overinflation.</p></sec><sec><title>Trial registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov/ct2/show/NCT02300337">NCT02300337</ext-link>. Registered: 20 November 2014.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12871-017-0308-4) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Genzwurker, H" uniqKey="Genzwurker H">H Genzwurker</name></author><author><name sortKey="Finteis, T" uniqKey="Finteis T">T Finteis</name></author><author><name sortKey="Hinkelbein, J" uniqKey="Hinkelbein J">J Hinkelbein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mandal, Ng" uniqKey="Mandal N">NG Mandal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Agro, F" uniqKey="Agro F">F Agro</name></author><author><name sortKey="Cataldo, R" uniqKey="Cataldo R">R Cataldo</name></author><author><name sortKey="Alfano, A" uniqKey="Alfano A">A Alfano</name></author><author><name 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sortKey="Heaney, M" uniqKey="Heaney M">M Heaney</name></author><author><name sortKey="Chambers, Na" uniqKey="Chambers N">NA Chambers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cattano, D" uniqKey="Cattano D">D Cattano</name></author><author><name sortKey="Ferrario, L" uniqKey="Ferrario L">L Ferrario</name></author><author><name sortKey="Patel, Cb" uniqKey="Patel C">CB Patel</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li></country></list><tree><country name="Allemagne"><noRegion><name sortKey="Kriege, Marc" sort="Kriege, Marc" uniqKey="Kriege M" first="Marc" last="Kriege">Marc Kriege</name></noRegion><name sortKey="Alflen, Christian" sort="Alflen, Christian" uniqKey="Alflen C" first="Christian" last="Alflen">Christian Alflen</name><name sortKey="Eisel, Johannes" sort="Eisel, Johannes" uniqKey="Eisel J" first="Johannes" last="Eisel">Johannes Eisel</name><name sortKey="Noppens, Ruediger R" sort="Noppens, Ruediger R" uniqKey="Noppens R" first="Ruediger R." last="Noppens">Ruediger R. Noppens</name><name sortKey="Ott, Thomas" sort="Ott, Thomas" uniqKey="Ott T" first="Thomas" last="Ott">Thomas Ott</name><name sortKey="Piepho, Tim" sort="Piepho, Tim" uniqKey="Piepho T" first="Tim" last="Piepho">Tim Piepho</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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