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Automatic regulation of the cuff pressure in endotracheally-intubated patients

¹ Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, and ² Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clinic Provincial, Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain

CORRESPONDENCE: R. Farré, Unitat de Biofisica i Bioenginyeria, Facultat de Medicina, Casanova 143, E-08036, Barcelona, Spain. Fax: 34 934024516. E-mail: farre@medicina.ub.es

Keywords: endotracheal intubation, mechanical ventilation, monitoring artificial ventilation, nosocomial pneumonia, tracheal tissue damage

Received: December 21, 2001
Accepted April 6, 2002

The present study was supported by Comisión Interministerial de Ciencia y Tecnología (CICYT; SAF99-0001) and Dirección General de Enseñanza Superior e Investigación Científica (DGESIC; PM98-0027).

To avoid tracheal wall damage or inadvertent falls of the endotracheal tube cuff pressure (P_cuff) in intubated and mechanically-ventilated patients, the authors devised a simple procedure for automatic and continuous regulation of P_cuff.

The procedure, only requiring a simple aquarium air pump and conventional tubing, was first tested at the bench when applied to an intubated and ventilated lung model, including an artificial trachea with an externally-variable section. The clinical performance of the procedure was tested in eight intubated patients, in whom the endotracheal tube cuff was connected to the designed P_cuff regulator during 24 h.

The bench test showed that the procedure was able to maintain P_cuff constant, regardless of the changes imposed in the tracheal section. It was also effective in maintaining P_cuff during routine mechanical ventilation. Actual P_cuff recorded over the 24-h period always coincided with the target value within ±2 cmH₂O in all the patients.

The procedure devised to maintain endotracheal tube cuff pressure is readily implemented, cheap, easy to operate and can be used regardless of the specific ventilator or tube used. Routine implementation of this procedure may be useful for protecting the trachea from tissue damage and for reducing the risk of ventilator-associated pneumonia.