title: Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study.
abstract: BACKGROUND
  Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness, and blood-streaked expectorant. In this study, we investigated the short-term (hours) impact of measuring and controlling endotracheal tube cuff (ETTc) pressure on postprocedural complications.
  
  
  METHODS
  Five hundred nine patients from 4 tertiary care university hospitals in Shanghai, China scheduled for elective surgery under general anesthesia were assigned to a control group without measuring ETTc pressure, and a study group with ETTc pressure measured and adjusted. The duration of the procedure and duration of endotracheal intubation were recorded. Twenty patients whose duration of endotracheal intubation was between 120 and 180 minutes were selected from each group and examined by fiberoptic bronchoscopy immediately after removing the endotracheal tube. Endotracheal intubation-related complications including cough, sore throat, hoarseness, and blood-streaked expectorant were recorded at 24 hours postextubation.
  
  
  RESULTS
  There was no significant difference in sex, age, height, weight, procedure duration, and duration of endotracheal intubation between the 2 groups. The mean ETTc pressure measured after estimation by palpation of the pilot balloon of the study group was 43 ± 23.3 mm Hg before adjustment (the highest was 210 mm Hg), and 20 ± 3.1 mm Hg after adjustment (P < 0.001). The incidence of postprocedural sore throat, hoarseness, and blood-streaked expectoration in the control group was significantly higher than in the study group. As the duration of endotracheal intubation increased, the incidence of sore throat and blood-streaked expectoration in the control group increased. The incidence of sore throat in the study group also increased with increasing duration of endotracheal intubation. Fiberoptic bronchoscopy in the 20 patients showed that the tracheal mucosa was injured in varying degrees in both groups, but the injury was more severe in the control group than in the study group.
  
  
  CONCLUSIONS
  ETTc pressure estimated by palpation with personal experience is often much higher than measured or what may be optimal. Proper control of ETTc pressure by a manometer helped reduce ETT-related postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours).
authors.affiliation: Department of Anesthesiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Liu
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Gong
authors.forename: Shitong
authors.initials: S
authors.lastname: Li
authors.forename: Fen
authors.initials: F
authors.lastname: Wang
authors.forename: Shukun
authors.initials: S
authors.lastname: Fu
authors.forename: Mazhong
authors.initials: M
authors.lastname: Zhang
authors.forename: Yannan
authors.initials: Y
authors.lastname: Hang
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods; D002681:China; D003371:Cough / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005336:Fiber Optic Technology; D006685:Hoarseness / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010612:Pharyngitis / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D020545:Respiratory Mucosa / Q000293:injuries* / Q000473:pathology; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome