title: Reduced Endotracheal Tube Cuff Pressure to Assess Dysphagia After Anterior Cervical Spine Surgery.
abstract: METHODS
  This was a prospective, randomized control pilot study.
  
  
  OBJECTIVE
  The aim of this study was to determine whether continuous monitoring and adjustment of the endotracheal tube cuff pressure (ETTCP) to 15 mm Hg during ACSS would alter the incidence of postoperative dysphagia.
  
  
  BACKGROUND
  Postoperative dysphagia is a recognized potential complication of anterior cervical spine surgery (ACSS). Recent findings on preventive measures suggest that certain intraoperative practices may minimize this complication.
  
  
  METHODS
  Fifty patients undergoing ACSS, arthroplasty, or fusion, completed routine lateral cervical preoperative plain films and questionnaires [Dysphagia Disability Index (DDI), Bazaz-Yoo Dysphagia Score (BYDS), and Short Form (36) Health Survey]. Patients were randomized into 2 groups: treatment group with ETTCP maintained at 15 mm Hg and control group with cuff pressure monitored without manipulation. Radiographs and questionnaires were obtained at 24 hours, 6 weeks, and 3 and 6 months postsurgery to assess soft tissue thickness and rates of dysphagia.
  
  
  RESULTS
  There were no significant differences between the groups in the soft tissue thickness or questionnaire scores at any timepoint (P>0.05). Within-group analysis revealed treatment and control groups had a significantly higher 24-hour postoperative soft tissue thickness and questionnaire scores compared with follow-up measurements (P<0.05). In the pooled group (n=50), the 24-hour postoperative DDI, BYDS, and soft tissue thickness were significantly higher compared with all other timepoints (P<0.01). DDI scores ≥10 related to dysphagia were in 59% of patients at 24 hours, 35% at 6 weeks, 24% at 3 months, and 18% at 6 months.
  
  
  CONCLUSIONS
  This study suggests decreased ETTCP has no effect on the prevalence of dysphagia. The incidence of dysphagia decreases over time and normalizes by 6 months postsurgery.
authors.affiliation: *Department of Medical Biophysics †Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University ‡Department of Clinical Neurological Sciences; Neurosurgery, University Hospital, London Health Sciences Centre, London, ON, Canada §St. Luke's Neurosurgical Associates, Bethlehem, PA ∥Department of Anesthesiology, University Hospital, London Health Sciences Centre, London, ON, Canada.
authors.forename: Izabela
authors.initials: I
authors.lastname: Kowalczyk
authors.forename: Won Hyung A
authors.initials: WH
authors.lastname: Ryu
authors.forename: Doron
authors.initials: D
authors.lastname: Rabin
authors.forename: Miguel
authors.initials: M
authors.lastname: Arango
authors.forename: Neil
authors.initials: N
authors.lastname: Duggal
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011312:Pressure; D011859:Radiography; D011795:Surveys and Questionnaires; D016896:Treatment Outcome