title: Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial.
abstract: BACKGROUND
  The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness.
  
  
  METHODS
  In a prospective, randomized clinical trial, 100 patients' tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported.
  
  
  RESULTS
  Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ≤ 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ≤ 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ≤ 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001).
  
  
  CONCLUSIONS
  The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications.
authors.affiliation: Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia ; Department of Anesthesiology, Ain Shams University, Cairo, Egypt.
authors.forename: Waleed A
authors.initials: WA
authors.lastname: Almarakbi
authors.affiliation: Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Kaki
keywords: Endotracheal tube cuff inflation guided by pressure volume loop closure is associated with the use of a lower cuff volume, and results in a lower cuff pressure and lower incidence of postoperative cuff-related complications when compared with the conventi; cuff pressure; cuff volume; cuff-related complications; pressure volume loop closure; tracheal tube