Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.001
Brazilian Journal of Anesthesiology
Scientific Article

Subjective method for tracheal tube cuff inflation: performance of anesthesiology residents and staff anesthesiologists. Prospective observational study

Insuflação de balonete de tubo traqueal por método subjetivo: desempenho de médicos residentes e especialistas em anestesiologia. Estudo prospectivo observacional

Nadia Maria da Conceição Duarte, Ana Maria Menezes Caetano, Gustavo de Oliveira Arouca, Andrea Tavares Ferrreira, José Luiz de Figueiredo

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Abstract

Background and objectives
Poor monitoring of tracheal tube cuff pressure may result in patient complications. The objective method of using a manometer is recommended to keep safe cuff pressure values (20‒30 cm H2O). However, as manometers are not readily available, anesthesiologists use subjective methods. We aimed to assess appropriateness of a subjective method for attaining cuff pressure and the expertise level of manometer handling among anesthesiology staff and residents in a university teaching hospital.

Methods
Prospective observational study, recruiting participants that performed tracheal intubation and the subjective method for tube cuff inflation. Patients with difficult airway, larynx and trachea anatomic abnormality and emergency procedures were not included. Up to 60 minutes after tracheal intubation, an investigator registered the cuff pressure using an aneroid manometer (AMBU®) connected to the tube pilot balloon.

Results
Forty-seven anesthesiologists were included in the study – 24 residents and 23 staff. Mean (SD) and medians (IQR) measured in cmH2O were, respectively, 52.5 (27.1) and 50 (30‒70). We registered 83% of measurements outside the recommended pressure range, with no difference between specialists and residents. The level of expertise with the objective method was also similar in both groups. Pressure adjustments were performed in 76.6% of cases.

Conclusion
The subjective method for inflating the tracheal tube cuff resulted in a high rate of inadequate cuff pressures, with no difference in performance between anesthesiology specialists and residents.

Keywords

Tracheal intubation;  Tracheal tube;  Cuff pressure;  Manometer;  Anesthesiologist

Resumo

Justificativa e objetivos
O controle inadequado da pressão dos balonetes dos tubos traqueais pode resultar em complicações. A técnica objetiva com uso de manômetro é a recomendada para manutenção de valores seguros de pressão (20‒30 cm H2O). Mas como este instrumento é pouco disponível, os anestesiologistas recorrem a técnicas subjetivas. O objetivo deste estudo foi avaliar a adequação da técnica subjetiva para obtenção das pressões dos balonetes e o nível de experiência com uso do manômetro entre médicos especialistas e residentes de anestesiologia de um Hospital Universitário.

Método
Estudo observacional prospectivo, com participantes que realizaram intubação traqueal e técnica subjetiva para insuflação dos balonetes. Pacientes com via aérea difícil, anormalidades anatômicas de laringe e traqueia, risco de broncoaspiração e os casos de emergência não foram incluídos. Até 60 minutos após a intubação, um investigador registrava a pressão do balonete utilizando um manômetro aneroide (AMBU®) conectado ao balonete guia do tubo.

Resultados
Quarenta e sete anestesiologistas foram incluídos no estudo – 24 residentes e 23 especialistas. As pressões (cm H2O) média (DP) e mediana (IQR) encontradas foram respectivamente; 52,5 (27,1) e 50 (30‒70). Da amostra, 83% estavam fora da faixa adequada de pressão, sem diferença entre especialistas e residentes. O nível de experiência com a técnica objetiva também foi semelhante entre os grupos. Correção da pressão foi realizada em 76,6% dos casos.

Conclusões
A técnica subjetiva para insuflar os balonetes dos tubos traqueais resultou em alta prevalência de pressões inadequadas, sem diferença no desempenho entre especialistas e residentes.

Palavras-chave

Intubação traqueal;  Tubo traqueal;  Pressão do balonete;  Manômetro;  Anestesiologista

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