Endotracheal Tube Cuff Pressure Alteration After Changes In Position In Patients Under Mechanical Ventilation [alteração Da Pressão Intra-cuff Do Tubo Endotraqueal Após Mudança Da Posição Em Pacientes Sob Ventilação Mecânica]

Objective: The purpose of this study was to investigate endotracheal tube cuff pressure (Pcuff) alteration in patients under mechanical ventilation after changes in position. Methods: All selected patients were initially placed in the 35° semi-Fowler position, with Pcuff adjusted to 20 mmHg, and randomly divided into two groups. Group A, in which patients were moved to the lateral decubitus position, facing away from the ventilator (measurement designated Pcuff A1), returned to the initial position (measurement designated Pcuff A2), moved to a lateral decubitus position, facing the ventilator (measurement designated Pcuff A3) and then returned to the initial position (measurement designated Pcuff A4); and Group B, in which patients were moved to the lateral decubitus position, facing the ventilator (measurement designated Pcuff B1), returned to the initial position (measurement designated Pcuff B2), moved to the lateral decubitus position; facing away from the ventilator (measurement designated Pcuff B3) and then returned to the initial position (measurement designated Pcuff B4). Results: The study comprised 70 patients, 31 allocated to group A and 39 allocated to group B. Values >22 mmHg were observed in 142(50.7%) of the 280 Pcuff measurements taken, and values 22 mmHg). Conclusions: Changes in body position can cause significant Pcuff variations in patients under mechanical ventilation.345294297Farré, R., Rotger, M., Ferre, M., Torres, A., Navajas, D., Automatic regulation of the cuff pressure in endotracheally-intubated patients (2002) Eur Respir J, 20 (4), pp. 1010-1013Schmidt, W.A., Schaap, R.N., Mortensen, J.D., Immediate mucosal effects of short-term, soft-cuff, endotracheal intubation. A light and scanning electron microscopic study (1979) Arch Pathol Lab Med, 103 (10), pp. 516-521Vyas, D., Inweregbu, K., Pittard, A., Measurement of tracheal tube cuff pressure in critical care (2002) Anaesthesia, 57 (3), pp. 275-277Mahul, P., Auboyer, C., Jospe, R., Ros, A., Guerin, C., el Khouri, Z., Prevention of nosocomial pneumonia in intubated patients: Respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis (1992) Intensive Care Med, 18 (1), pp. 20-25Torres, A., El-Ebiary, M., Soler, N., Montón, C., Fàbregas, N., Hernández, C., Stomach as a source of colonization of the respiratory tract during mechanical ventilation: Association with ventilator-associated pneumonia (1996) Eur Respir J, 9 (8), pp. 1729-1735Mehta, S., Mickiewicz, M., Pressure in large volume, low pressure cuffs: Its significance, measurement and regulation (1985) Intensive Care Med, 11 (5), pp. 267-272Berlauk, J.F., Prolonged endotracheal intubation vs. tracheostomy (1986) Crit Care Med, 14 (8), pp. 742-745Sarper, A., Ayten, A., Eser, I., Ozbudak, O., Demircan, A., Tracheal stenosis aftertracheostomy or intubation: Review with special regard to cause and management (2005) Tex Heart Inst J, 32 (2), pp. 154-158Fan, C.M., Ko, P.C., Tsai, K.C., Chiang, W.C., Chang, Y.C., Chen, W.J., Tracheal rupture complicating emergent endotracheal intubation (2004) Am J Emerg Med, 22 (4), pp. 289-293Badenhorst, C.H., Changes in tracheal cuff pressure during respiratory support (1987) Crit Care Med, 15 (4), pp. 300-302Nseir, S., Di Pompeo, C., Pronnier, P., Beague, S., Onimus, T., Saulnier, F., Nosocomial tracheobronchitis in mechanically ventilated patients: Incidence, aetiology and outcome (2002) Eur Respir J, 20 (6), pp. 1483-1489Rumbak, M.J., The pathogenesis of ventilator-associated pneumonia (2002) Semin Respir Crit Care Med, 23 (5), pp. 427-434Bernhard, W.N., Yost, L., Joynes, D., Cothalis, S., Turndorf, H., Intracuff pressures in endotracheal and tracheostomy tubes. Related cuff physical characteristics (1985) Chest, 87 (6), pp. 720-725Wunderink, R.G., Nosocomial pneumonia, including ventilator-associated pneumonia (2005) Proc Am Thorac Soc, 2 (5), pp. 440-444Klainer, A.S., Turndorf, H., Wu, W.H., Maewal, H., Allender, P., Surface alterations due to endotracheal intubation (1975) Am J Med, 58 (5), pp. 674-683Wiswell, T.E., Turner, B.S., Bley, J.A., Fritz, D.L., Hunt, R.E., Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation (1989) Pediatrics, 84 (2), pp. 304-31