Evaluation of tracheal cuff pressure variation in spontaneously breathing patients.
BACKGROUND
Most of the studies referring cuff tubes' issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation.


OBJECTIVE
To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center.


METHODS
Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry.


RESULTS
In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings.


CONCLUSIONS
The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently.
Respiratory Care Services, Clínica Basilea, Argentina ; Intensive Care Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
Gustavo A
GA
Plotnikow
Respiratory Care Services, Clínica Basilea, Argentina.
Nicolas
N
Roux
Respiratory Care Services, Clínica Basilea, Argentina.
Viviana
V
Feld
Respiratory Care Services, Clínica Basilea, Argentina.
Emiliano
E
Gogniat
Respiratory Care Services, Clínica Basilea, Argentina.
Dario
D
Villalba
Respiratory Care Services, Clínica Basilea, Argentina.
Noelia Vairo
NV
Ribero
Respiratory Care Services, Clínica Basilea, Argentina.
Marisa
M
Sartore
Respiratory Care Services, Clínica Basilea, Argentina.
Mauro
M
Bosso
Respiratory Care Services, Clínica Basilea, Argentina ; Intensive Care Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
Corina
C
Quiroga
Respiratory Care Services, Clínica Basilea, Argentina ; Intensive Care Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
Valeria
V
Leiva
Respiratory Care Services, Clínica Basilea, Argentina.
Mariana
M
Scrigna
Respiratory Care Services, Clínica Basilea, Argentina.
Facundo
F
Puchulu
Respiratory Care Services, Clínica Basilea, Argentina.
Eduardo
E
Distéfano
Intensive Care Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
Jose Luis
JL
Scapellato
Intensive Care Unit, Sanatorio Anchorena, Buenos Aires, Argentina.
Dante
D
Intile
Respiratory Care Services, Clínica Basilea, Argentina.
Fernando
F
Planells
Respiratory Care Services, Clínica Basilea, Argentina.
Diego
D
Noval
Respiratory Care Services, Clínica Basilea, Argentina.
Pablo
P
Buñirigo
Respiratory Care Services, Clínica Basilea, Argentina.
Ricardo
R
Jofré
Respiratory Care Services, Clínica Basilea, Argentina.
Ernesto Díaz
ED
Nielsen
Artificial airway; cuff pressure; decannulation; prolonged mechanical ventilation; tracheostomy; ventilator-associated pneumonia