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The effects of two endotracheal tube cuff inflation pressures on liquid aspiration and tracheal wall damage in horses.
Abstract: To investigate the effect of endotracheal tube cuff inflation pressure on the occurrence of liquid aspiration and tracheal wall damage. Methods: Prospective, randomized experimental study. Methods: Ten healthy horses, weighing 535 +/- 55 kg. Methods: Horses were anesthetized, orotracheally intubated, placed in dorsal recumbency, and maintained on isoflurane in oxygen with controlled ventilation for 175 +/- 15 minutes. The horses were randomly assigned to an endotracheal cuff pressure of 80-100 or 120 cm H2O. The cuff pressure was continuously monitored and maintained at a constant pressure. Methylene blue in saline was instilled proximal to the cuff. After euthanasia, the trachea was opened distal to the endotracheal tube tip to check for evidence of dye leaking past the cuff. The cervical trachea was then resected and opened longitudinally for gross and histologic examinations. Results: No blue staining was found distal to the cuff in any horse. Visual examination of the tracheal mucosa revealed hyperemic and hemorrhagic lesions at the site of the cuff contact. Histologic changes included epithelium attenuation or erosion, submucosal neutrophilic infiltration, and submucosal hemorrhages. Lesions were absent or less extensive in the lower cuff pressure group as compared to the high cuff pressure group. Conclusions: The endotracheal tube cuff produced a seal sufficient to prevent leakage in both groups. Tracheal wall damage was more severe and occurred more frequently in the higher cuff pressure group. Conclusions: Tracheal mucosal damage induced by cuff inflation is pressure-dependent. Cuff pressure monitoring is recommended.
Publication Date: 2005-01-25 PubMed ID: 15663736DOI: 10.1111/j.1467-2995.2004.00170.xGoogle Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Clinical Trial
- Journal Article
- Randomized Controlled Trial
Summary
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This research investigates the impacts of different inflation pressures in endotracheal tube cuffs on horses, particularly focusing on the potential for liquid aspiration and damage to the tracheal wall. The study found that both higher and lower pressure cuffs were efficient in preventing leakage, but higher pressure cuffs were associated with increased tracheal wall damage.
Methodology
- The study was a prospective, randomized experimental study involving ten healthy horses, with each weighing between 480 and 590 kg.
- Each horse was anesthetized, intubated through the mouth into the trachea, laid on its back, and maintained on isoflurane (an anesthetic) in oxygen with controlled ventilation for about 160 to 190 minutes.
- Randomly, the horses were assigned an endotracheal cuff pressure of 80-100 cm H2O or 120 cm H2O. The pressure in the cuff was continuously monitored and kept constant.
- At the site above the cuff, a solution of methylene blue in saline was instilled. This dye aids in visual detection of leaks or seepages.
- Following euthanasia, the horse’s trachea was opened below the tube’s tip to inspect for any dye that may have leaked past the cuff. The cervical trachea was then removed and opened lengthwise for both gross and microscopic examination.
Results
- No blue staining was found below the cuff in any of the horses, indicating that no leakage had occurred in any of the subjects.
- The visual inspection showed reddened and bloody lesions where the cuff had contacted the tracheal mucosa.
- The histologic examinations noted changes including thinning or abrasion of the epithelium, infiltration of neutrophils into the submucosa, and submucosal hemorrhages.
- These lesions were absent or less prominent in the group with the lower cuff inflation pressure compared to the group with the high cuff pressure.
Conclusions
- Both high and low endotracheal tube cuff pressures proved efficient in preventing leakage.
- However, the group with the higher cuff pressure suffered more severe and frequent tracheal wall damage.
- The damage to the tracheal mucosa from cuff inflation was found to be pressure-dependent.
- Based on these results, the study suggests that careful monitoring of cuff pressure during intubation procedures is recommended to minimize potential tracheal wall damage.
Cite This Article
APA
Touzot-Jourde G, Stedman NL, Trim CM.
(2005).
The effects of two endotracheal tube cuff inflation pressures on liquid aspiration and tracheal wall damage in horses.
Vet Anaesth Analg, 32(1), 23-29.
https://doi.org/10.1111/j.1467-2995.2004.00170.x Publication
Researcher Affiliations
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA. gwenola@lamar.colostate.edu
MeSH Terms
- Anesthesia
- Animals
- Female
- Horses / surgery
- Intubation, Intratracheal / adverse effects
- Male
- Pneumonia, Aspiration / etiology
- Pneumonia, Aspiration / veterinary
- Pressure
- Prospective Studies
- Trachea / pathology
- Treatment Outcome
Citations
This article has been cited 11 times.- Veen I, de Grauw JC. Methods Used for Endotracheal Tube Cuff Inflation and Pressure Verification in Veterinary Medicine: A Questionnaire on Current Practice. Animals (Basel) 2022 Nov 8;12(22).
- Wang R, Qin X, Zhou W, Zhao Y, Yin J, Cao Z, Zhai J, Wang S. The Relationship between Cuff Pressure and Air Injection Volume of Endotracheal Tube: A Study with Sheep Trachea Ex Vivo. Appl Bionics Biomech 2022;2022:1748233.
- Hung WC, Ko JC, Weil AB, Weng HY. Evaluation of Endotracheal Tube Cuff Pressure and the Use of Three Cuff Inflation Syringe Devices in Dogs. Front Vet Sci 2020;7:39.
- Luo L, Li H, Zhou L, Zhou J, Ni J, Zhou R. The lowest effective intracuff pressure of the esophagus obstruction tube to prevent reflux of gastric contents: a study on rabbits. J Anesth 2014 Aug;28(4):499-504.
- Touat L, Fournier C, Ramon P, Salleron J, Durocher A, Nseir S. Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome. Intensive Care Med 2013 Apr;39(4):575-82.
- Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, Ludy JE, Bennett M. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care 2011 Mar;20(2):109-17; quiz 118.
- Hoffman RJ, Dahlen JR, Lipovic D, Stürmann KM. Linear correlation of endotracheal tube cuff pressure and volume. West J Emerg Med 2009 Aug;10(3):137-9.
- Nseir S, Duguet A, Copin MC, De Jonckheere J, Zhang M, Similowski T, Marquette CH. Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care 2007;11(5):R109.
- Parente A, Geburek F, Kästner S, Iversen C, Hopster K. Prevalence and degree of orotracheal intubation-related tracheal lesions in horses. Equine Vet J 2025 Nov;57(6):1556-1562.
- Zhang P, Yang Q, Yin C, Cai Z, Lu H, Li H, Li L, Tian Y, Bai L, Huang L. Association between septic shock and tracheal injury score in intensive care unit patients with invasive ventilation: a prospective single-centre cohort study in China. BMJ Open 2024 May 13;14(5):e078763.
- Kumar AA. Endotracheal Cuff-pressure Monitoring in ICU: A Standard of Care Yet to be Standardized, and Often Neglected. Indian J Crit Care Med 2024 Jan;28(1):8-10.
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