The Effect of Intraoperative Transesophageal Echocardiography Probe Placement on the Endotracheal Tube Cuff Pressure in Adult Patients Undergoing On-Pump Cardiac Surgery

Effect of Transesophageal Echocardiography Probe Insertion on Endotracheal Tube Cuff Pressure in Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery. A Prospective Randomized Control Trial

INTRODUCTION

Elevated endotracheal tube (ETT) cuff pressures during surgery can lead to tracheal ischemia and airway complications, including postoperative sore throat, subglottic edema, and tracheal stenosis. The insertion of a transesophageal echocardiography (TEE) probe, commonly used in cardiac surgeries, may increase ETT cuff pressure due to its proximity to the trachea. This study assesses the impact of TEE probe insertion on ETT cuff pressures and related postoperative airway complications in patients undergoing coronary artery bypass graft (CABG) surgery.

METHODS

In this prospective, randomized controlled trial, 40 patients undergoing CABG were assigned to either a control group (Group C, n = 20) or an intervention group (Group T, n = 20). Cuff pressures were monitored at baseline (T1), during TEE probe manipulation (T2), after initial examination (T3), and during recovery (T4). In Group T, cuff pressures were adjusted to 20-30 cmH2O if they exceeded 30 cmH2O during T2 and T3. Postoperative complications, including sore throat, hoarseness, and cough, were assessed using standardized scales.

RESULTS

TEE probe manipulation significantly increased ETT cuff pressures in both groups, with lower pressures consistently observed in Group T (P < 0.05). At T3, the mean cuff pressure in Group C was 41.00 cmH2O versus 33.30 cmH2O in Group T (P < 0.001). The control group experienced more severe postoperative airway complications, while Group T had a significantly reduced risk of severe complications (odds ratio < 0.2).

CONCLUSION

TEE probe manipulation significantly increases ETT cuff pressures, but cuff deflation during manipulation effectively reduces these pressures and lowers the risk of postoperative airway complications.

Effect of transesophageal echocardiography probe on tracheal perfusion pressure and ventilatory parameters in pediatric patients undergoing cardiac surgery using cardiopulmonary bypass: A prospective observational study

Background

Overinflation of cuffed endotracheal tubes and transesophageal echocardiography (TEE) probe causes increased intracuff pressure (CP) compromising tracheal perfusion pressure (TPP). Primary objective of the study was to assess CP, TPP on TEE probe insertion and examination during pediatric cardiac surgeries. Secondary objectives were to evaluate the effect of the probe on peak airway pressures (Ppeak), mean airway pressures (Pmean) and to monitor CP, TPP on cardiopulmonary bypass (CPB).

Materials and Methods

This prospective observational study included fifty patients, aged 1-5 years undergoing cardiac surgeries using CPB. Following induction, TEE probe was introduced. CP, TPP, Ppeak, Pmean were measured before insertion of TEE probe (T1), during probe insertion (T2) and examination at mid-esophageal (T3), transgastric level (T4), and on removing probe (T6). CP, TPP were monitored on CPB (T5). Statistical analysis was done using paired t-test.

Results

CP, Ppeak and Pmean increased significantly, while TPP decreased significantly from T1 to T2, T3, T4 (P < 0.001). CP, TPP decreased significantly at T5 in comparison to T6 (P < 0.001). In 48% of the patients CP increased above 30 cm H2O at T2.

Conclusion

TEE probe causes an increase in CP and decreases TPP. Constant monitoring and maintaining CP, TPP in optimum range is recommended.

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH₂O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH₂O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.