Continuous adjustment of tracheal tube cuff pressure benefits patients undergoing laparoscopic resection of colorectal neoplasms: Study

Laparoscopic procedures are a frequently chosen option for removing colorectal growths. During these surgeries, the use of carbon dioxide pneumoperitoneum and Trendelenburg positioning can substantially raise airway pressure if endotracheal tube cuff pressure is not supervised. Recent prospective observational study conducted by Cai et al. aimed to evaluate the indicators, changes, and correlation factors of endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms. The study included 122 patients scheduled for laparoscopic surgery under total intravenous anesthesia with orotracheal intubation. Tracheal tube cuff pressure was continuously monitored using calibrated pressure transducers. The study found that waist-to-hip ratio had the highest predictive ability for out-of-range tracheal cuff pressure, with a cuff pressure of 41.0 cmH2O at the start. Throughout the surgery, cuff pressure significantly increased to 33.7 ± 2.9 cmH2O at 15 minutes post-insufflation.

Associations and Predictors of Cuff Pressure

Multiple linear regression analysis showed that tracheal tube cuff pressure was associated with peak airway pressure. It was concluded that patients with normal BMI undergoing laparoscopic resection require continuous monitoring and timely adjustment of cuff pressure. Waist-to-hip ratio was identified as a better predictor of cuff pressure than BMI. The study indicated that tracheal tube cuff pressure could rise significantly during laparoscopic surgery, potentially leading to airway complications if not monitored and adjusted properly. The study highlighted the importance of monitoring cuff pressure to prevent complications associated with overinflation, such as tracheal mucosa ischemia, sore throat, and tracheal wall perfusion issues. The results emphasize the need for continuous monitoring and adjustment of cuff pressure, especially during pneumoperitoneum. Peak airway pressure was found to be significantly higher during this period and was associated with changes in cuff pressure.

Detailed Measurements and Recommendations

The study provided detailed measurements and time points for cuff pressure, peak airway pressure, and tidal volume during different stages of the surgery. The findings suggest that patients with larger waist circumference and smaller hip circumference may be more prone to exceeding recommended cuff pressures, leading to potential respiratory compliance issues. Future multicenter studies and investigations into longer procedures are suggested to further validate the study's findings and implications for clinical practice.

Key Points

1. The study by Cai et al. focused on assessing endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms in 122 patients under total intravenous anesthesia. Monitoring cuff pressure was done using calibrated pressure transducers, with a starting cuff pressure of 41.0 cmH2O which significantly increased to 33.7 ± 2.9 cmH2O at 15 minutes post-insufflation.

2. Waist-to-hip ratio was identified as the most predictive indicator of out-of-range cuff pressure, suggesting that patients with abnormal waist-to-hip ratios may be at higher risk of complications related to cuff pressure during laparoscopic surgery.

3. The study revealed a significant association between tracheal tube cuff pressure and peak airway pressure, highlighting the importance of continuous monitoring and adjustment of cuff pressure, especially in patients with normal BMI undergoing laparoscopic resection to prevent potential airway complications.

4. Overinflation of cuff pressure during laparoscopic surgery may lead to adverse effects like tracheal mucosa ischemia, sore throat, and tracheal wall perfusion issues, underscoring the critical need for vigilant monitoring and timely adjustment of cuff pressure to mitigate these risks.

5. Detailed measurements and time points for cuff pressure, peak airway pressure, and tidal volume were provided, indicating that patients with larger waist circumference and smaller hip circumference may be more susceptible to exceeding recommended cuff pressures, potentially resulting in respiratory compliance challenges.

6. The study concludes by recommending future multicenter studies and investigations focusing on longer procedures to validate the findings and implications for clinical practice, emphasizing the necessity of continuous monitoring and adjustment of cuff pressure, particularly during pneumoperitoneum when peak airway pressure is significantly higher and influences cuff pressure changes.

Reference –

Cai, S., Wang, X., Zhang, J. et al. Changes of endotracheal tube cuff pressure and its indicators in laparoscopic resection of colorectal neoplasms: an observational prospective clinical trial. BMC Anesthesiol 24, 413 (2024). https://doi.org/10.1186/s12871-024-02802-4