title: Increased tracheal cuff pressure during insertion of a transoesophageal echocardiography probe: A prospective, observational study.
abstract: BACKGROUND
  Excessive tracheal cuff pressure reduces tracheal mucosal blood flow and increases tracheal morbidity. Inserting a transoesophageal echocardiography (TOE) probe has been shown to increase tracheal cuff pressure.
  
  
  OBJECTIVE
  To evaluate the effect of inserting a TOE probe on tracheal cuff pressure and compare the effect in patients who received a single-lumen endotracheal tube (SLT) with those who received a double-lumen endotracheal tube (DLT).
  
  
  METHODS
  A prospective, observational study.
  
  
  METHODS
  Single-centre trial, study period from October 2013 to January 2014.
  
  
  METHODS
  Forty-four adult patients scheduled for elective cardiothoracic surgery requiring intraoperative TOE monitoring.
  
  
  METHODS
  After tracheal intubation with a SLT (n = 22) or DLT (n = 22), the tracheal cuff was inflated to 18 mmHg (25 cmH2O) with air. Tracheal cuff pressure was monitored continuously for 5 min after inserting the TOE probe.
  
  
  METHODS
  The primary endpoint was steady-state tracheal cuff pressure after insertion of the TOE probe.
  
  
  RESULTS
  Median (interquartile range, IQR) tracheal cuff pressure stabilised at 3 (2 to 3) min in the SLT group and at 2 (1 to 3) min in the DLT group. Steady-state cuff pressure was significantly higher in the DLT group than that in the SLT group [36.7 (31.3 to 44.1) vs. 31.3 (29.6 to 35.7) cmH2O; (P = 0.03)]. Steady-state cuff pressure more than 40 cmH2O was observed in two patients (18.2%) in the SLT group and nine patients (40.9%) in the DLT group (P = 0.02).
  
  
  CONCLUSIONS
  Insertion of a TOE probe increased tracheal cuff pressure in both the SLT and DLT groups. The increase in cuff pressure was greater in patients who received a DLT. Frequent measurement and adjustment of cuff pressure should be emphasised particularly when TOE is used in patients receiving a DLT.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT02034643.
authors.affiliation: From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (TKK, J-HS, Y-HL, J-WJ, J-HB, DMH, YJ), and Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Seoul, Korea (JJM).
authors.forename: Tae Kyong
authors.initials: TK
authors.lastname: Kim
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Min
authors.forename: Jeong-Hwa
authors.initials: JH
authors.lastname: Seo
authors.forename: Yong-Hun
authors.initials: YH
authors.lastname: Lee
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Ju
authors.forename: Jae-Hyon
authors.initials: JH
authors.lastname: Bahk
authors.forename: Deok Man
authors.initials: DM
authors.lastname: Hong
authors.forename: Yunseok
authors.initials: Y
authors.lastname: Jeon
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D011312:Pressure / Q000009:adverse effects; D011446:Prospective Studies; D014132:Trachea / Q000502:physiology