Control of tracheal cuff pressure: a pilot study using a pneumatic device

Abstract Objective: To evaluate the efficacy of a simple mechanical device to maintain constant endotracheal cuff pressure (Pcuff) during mechanical ventilation (large encased inflatable cuff connected to the endotracheal cuff and receiving constant pressure from a heavy mass attached to an articulated arm). Design and setting: Single-center, prospective, randomized, crossover, pilot study in a medical intensive care unit. Patients and participants: Nine consecutive mechanically ventilated patients (age 62 ± 20 years, SAPS II score 39 ± 15). Interventions: Control day: Pcuff monitored and adjusted with a manometer (Hi-Lo™, Tyco Healthcare) according to current recommendations (twice a day and after each intervention on the tracheal tube); initial target Pcuff 22-28 cmH 2 0. Prototype day: test device connected to the endotracheal cuff; same initial target. Continuous Pcuff recording during both days. Control and prototype days in random order. Results: Pcuff values over 50 cmH 2 0 were recorded in six patients during the control day (178 ± 159 min), never during the prototype day. During the control day, Pcuff was between 30 and 50 cmH 2 0 for 29 ± 25% of the time, vs 0.3 ± 0.3% during the prototype day (p < 0.01). Pcuff was between 15 and 30 cmH 2 0 for 56 ± 36% of the time during the control day, vs 95 ± 14% during the prototype day (p < 0.01). During the control day, Pcuff was below 15 cmH 2 0 for 15 ± 17% of the time, vs 4.7 ± 15% during the prototype day (p < 0.05). Conclusions: The tested device successfully controlled Pcuff with minimal human resource consumption. Prospective studies are required to assess its clinical impact