Effect of varying cuff sizes with identical inner diameter on endotracheal intubation in critically ill adults: A sealed tracheal controlled trial

• Published in: Medicine (Baltimore) Vol. 103; no. 24; p. e38326
• Main Authors: Zhang, Yan-Nan, Shi, Hai-Yan, Shen, Wang-Qin, Shi, Jia-Hai, Zhu, Yan-Ping, Xu, Yang-Hui, Wu, Hong-Lei
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 14.06.2024
• Subjects: Adult; Aged; Clinical Trial/Experimental Study; Critical Illness; Equipment Design; Female; Humans; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Male; Middle Aged; Trachea; cuff size; cuff pressure; unsealed trachea
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000038326

Background: The present study aims to determine the impact of different cuff diameters on the cuff pressure of endotracheal tubes (ETTs) when the trachea is adequately sealed. Methods: In the present single-center clinical trial, adult patients who underwent cardiothoracic surgery were assigned to use ETTs from 2 brands (GME and GZW). The primary endpoint comprised of the following: cuff diameter, inner diameter of the ETT, manufacturer, and the number of subjects with tracheal leakage when the cuff pressure was 30 cm H2O. Results: A total of 298 patients were assigned into 2 groups, based on the 2 distinct brands of ETTs: experimental group (n = 122, GME brand) and control group (n = 176, GZW brand). There were no significant differences in baseline characteristics. However, the cuff diameter was significantly smaller in the control group, when compared to the experimental group (P = .001), and the incidence of tracheal leakage was significantly higher in the control group (P = .001). Furthermore, the GME brand ETT had a significantly larger cuff diameter, when compared to the GZW brand ETT. Conclusion: The cuff size would mismatch the tracheal area in clinical practice. Therefore, chest computed tomography is recommended to routinely evaluate the tracheal cross-sectional area during anesthesia, in order to ensure the appropriate cuff size selection.