title: Clinical use of the volume-time curve for endotracheal tube cuff management.
abstract: BACKGROUND
  Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting.
  
  
  METHODS
  A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale.
  
  
  RESULTS
  The volume-time curve group presented significantly lower cuff pressure (30.9 ± 2.8 vs 37.7 ± 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ± 1.8 vs 7.1 ± 1.7), better preservation of FVC (49.5 ± 9.9 vs 41.8 ± 12.9%, P = .005), and FEV1 (46.6 ± 1.8 vs 38.6 ± 1.4%, P = .005) compared with the MOV group.
  
  
  CONCLUSIONS
  The subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.
authors.affiliation: Cardiology Division.
authors.forename: Douglas Willian
authors.initials: DW
authors.lastname: Bolzan
authors.affiliation: Cardiology Division Cardiovascular Surgery Discipline, Pirajussara and São Paulo Hospitals, Federal University of São Paulo, São Paulo, Brazil. wjgomes.dcir@epm.br.
authors.forename: Walter Jose
authors.initials: WJ
authors.lastname: Gomes
authors.affiliation: Cardiology Division.
authors.forename: Thatiana Cristina Alves
authors.initials: TC
authors.lastname: Peixoto
authors.affiliation: Pneumology Division, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Sônia Maria
authors.initials: SM
authors.lastname: Faresin
authors.affiliation: Cardiology Division.
authors.forename: Antônio Carlos de Camargo
authors.initials: AC
authors.lastname: Carvalho
authors.affiliation: Cardiology Division.
authors.forename: Angelo Amato Vincenzo
authors.initials: AA
authors.lastname: De Paola
authors.affiliation: Cardiology Division Department of Human Movement Sciences, Physical Therapy School of the Federal University of São Paulo, Santos, São Paulo, Brazil.
authors.forename: Solange
authors.initials: S
authors.lastname: Guizilini
mesh_terms: D060666:Airway Extubation; D003371:Cough / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods*; D011312:Pressure
keywords: cough; cuff pressure; endotracheal tube; sore throat; volume-time curve, and minimal occlusive volume