Effect of different patient positions on endotracheal tube cuff pressure in patients undergoing urological procedures: a prospective study

Abstract

BACKGROUND: The endotracheal tube (ETT) contains a cuff that is placed in the trachea to prevent gas leakage and aspiration of secretions and gastric contents. However, patient positioning after intubation may cause ETT displacement and changes in cuff pressure. OBJECTIVES: Evaluate the effect of different patient positions on ETT cuff pressure in patients undergoing urological procedures in supine, prone, lateral flank, and lithotomy positions. DESIGN: Prospective and observational study SETTING: A university hospital in Turkey PATIENTS AND METHODS: Patients who underwent surgeries under general anesthesia in different patient positions were involved. After intubation (T0), the cuff pressure was checked with a manometer and adjusted to 25 cmH2O and continuously monitored. The cuff pressure was checked before (T1) and after achieving the final position (T2) and then at 5, (T3), 10, (T4), 15 minutes (T5) of the position, at the end of the procedure (T6) and before extubation (T7). At postoperative 2nd and 12th hours, the patients were interviewed for sore throat, hoarseness, and cough. MAIN OUTCOME MEASURES: The effect of different patient positions on the ETT cuff pressure. SAMPLE SİZE: 200 patients RESULTS: The cuff pressure increased significantly at T2 in the lithotomy, lateral flank, and prone groups (P<.001 each). The highest increase in cuff pressure occurred in the prone group (34.3 [7.5] cmH2O). Over time, the cuff pressure decreased in all groups during surgery. Postoperative complications at the 2nd postoperative hour were similar in all groups; however, the mean cuff pressure was significantly higher in the patients with postoperative sore throat or cough (sore throat: P=.003; cough: P=.047). CONCLUSION: ETT cuff pressures are affected by different patient positioning; therefore, regular recording and adjustment of cuff pressure are necessary for patient safety. LIMITATION: We used ETT of a single manufacturer. Therefore, our findings may not be applicable to other types of ETT.