How important is it to Manage ETT Cuff Pressure During TEE Probe Use in CABG Patients?

Recent prospective randomized controlled trial investigated the impact of transesophageal echocardiography (TEE) probe insertion on cuff pressures of endotracheal tubes (ETT) in patients undergoing coronary artery bypass graft (CABG) surgery. The study targeted the potential elevation of cuff pressures during TEE procedures, which can compromise tracheal mucosa perfusion, leading to postoperative complications like sore throat, hoarseness, cough, and subglottic edema.

Patient Recruitment and Study Design

Forty patients aged 18-70, categorized under ASA physical status 1, 2, and 3, were recruited from a tertiary care center and randomly divided into a control group (Group C) and a test group (Group T), each containing 20 patients. Group C had cuff pressures monitored without adjustments, while in Group T, cuff pressures exceeding 30 cmH2O were adjusted to maintain a target pressure between 20-30 cmH2O using an Airway Cuff Pressure Gauge. Both groups underwent standardized anesthetic induction and were ventilated according to specific parameters.

Measurement and Assessment Techniques

Cuff pressures were documented at four stages: pre-TEE insertion (T1), during manipulation of the TEE probe (T2), immediately after the procedure (T3), and post-recovery (T4). Parameters were assessed for demographic equivalency and to ensure no notable differences in factors such as age, sex, or ETT size would bias results. Statistical analyses included paired t-tests and repeated measures ANOVA for cuff pressures, with Chi-square tests for comparing postoperative complications.

Findings on Cuff Pressure Management

Findings indicated that the mean cuff pressure was significantly lower in Group T at all measured intervals compared to Group C, evidencing the effect of the cuff management intervention (T1: 19.40 mmHg in Group T vs. 21.70 mmHg in Group C; T2: 25.10 mmHg vs. 27.30 mmHg; T3: 33.30 mmHg vs. 41.00 mmHg; T4: 25.60 mmHg vs. 32.10 mmHg).

Postoperative Airway Complications Analysis

Postoperative airway complications were notably less severe in Group T, with a lower proportion of patients reporting moderate to severe sore throat (25% in Group C vs. data from Group T), hoarseness of voice (30% of Group T having no hoarseness vs. 30% of Group C having moderate/severe hoarseness), and cough severity (50% of Group T reporting mild vs. 50% of Group C reporting moderate/severe). Statistical analysis confirmed significant differences with p-values less than 0.001 across all assessed complications.

Correlation and Logistic Regression Findings

Moreover, a moderate to strong positive correlation between elevated cuff pressures and the severity of complications was noted (Pearson correlation coefficients ranging from 0.5 to 0.7). Logistic regression further reinforced the positive effect of cuff pressure management, with Group T demonstrating a significantly reduced risk for severe complications, indicating an odds ratio likely less than 0.2.

Conclusion and Implications for Practice

These results underline the critical role of managing ETT cuff pressures during the insertion and manipulation of TEE probes. They advocate for proactive cuff deflation techniques to mitigate the risk of increased cuff pressure and consequently lower the incidence of postoperative airway complications among cardiac surgical patients. The study solidifies the premise that cuff management strategies are essential for improving patient outcomes in the context of surgeries incorporating TEE. Overall, findings are congruent with existing literature, suggesting that enhanced awareness and procedural modifications related to cuff pressures can yield significant improvements in patient care within surgical environments.

Key Points

- A randomized controlled trial evaluated the impact of transesophageal echocardiography (TEE) probe insertion on endotracheal tube (ETT) cuff pressures during coronary artery bypass graft (CABG) surgery, highlighting the risks of compromised tracheal mucosa perfusion leading to complications such as sore throat and hoarseness.

- Forty patients aged 18-70 with ASA physical status 1, 2, and 3 were enrolled and divided into a control group (Group C) and a test group (Group T). While Group C had cuff pressures monitored without adjustments, Group T adjusted cuff pressures exceeding 30 cmH2O to a target range of 20-30 cmH2O.

- Cuff pressures were measured at four key intervals: before TEE insertion, during TEE probe manipulation, immediately after the procedure, and upon recovery, ensuring demographic equivalency among participants with no significant differences that could bias results.

- Results indicated that mean cuff pressures were significantly lower in Group T across all measured intervals (T1: 19.40 mmHg vs. 21.70 mmHg; T2: 25.10 mmHg vs. 27.30 mmHg; T3: 33.30 mmHg vs. 41.00 mmHg; T4: 25.60 mmHg vs. 32.10 mmHg).

- Group T experienced fewer postoperative airway complications, with a lower percentage of patients reporting moderate to severe sore throat (25% vs. Group T), no hoarseness of voice in 30% of Group T compared to 30% experiencing moderate/severe in Group C, and reduced cough severity (50% reporting mild in Group T vs. moderate/severe in Group C). Statistically significant differences were noted with p-values less than 0.001.

- A moderate to strong positive correlation was observed between higher cuff pressures and the severity of complications, with Pearson correlation coefficients ranging from 0.5 to 0.7. Logistic regression analysis indicated a significantly reduced risk for severe complications in Group T, with an odds ratio of less than 0.2, underscoring the necessity of cuff management in surgical contexts involving TEE.

Reference –

A. Kireeti et al. (2025). Effect Of Transesophageal Echocardiography Probe Insertion On Endotracheal Tube Cuff Pressure In Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery. A Prospective Randomized Control Trial.. *Annals Of Cardiac Anaesthesia*, 28 2, 143-148 . https://doi.org/10.4103/aca.aca_175_24.

The findings highlight the crucial need to monitor and manage endotracheal tube (ETT) cuff pressures during the insertion and adjustment of transesophageal echocardiography (TEE) probes. Proactive cuff deflation strategies are recommended to prevent pressure spikes and reduce the risk of postoperative airway complications in cardiac surgery patients.