Application of a Loss of Resistance Syringe for Obtaining the Adequate Cuff Pressures of Endotracheal Intubated Patients in an Emergency Department

Kim, Hye Mi; No, Jong Kab; Cho, Young Soon; Kim, Ho Jung

Abstract

PURPOSE
The endotracheal tube cuff pressure must be kept within the optimal range. This study compared the usefulness of the conventional pilot balloon palpation technique using a 10 cc disposable syringe and passive release technique using a Loss of Resistance (LOR) syringe for obtaining adequate intracuff pressures of endotracheal intubated patients in an emergency department.
METHODS
This was a prospective, observational study, conducted at the emergency department of a university teaching hospital. Patients who required endotracheal intubation in an emergency department were enrolled in this study. The patients were divided into two groups: one group who underwent the pilot balloon palpation technique using a conventional syringe (group A, n=40) and the other group who underwent the passive release technique using a LOR syringe technique (group B, n=40). The amount of air that infused into the cuff and the cuff pressure were measured.
RESULTS
The mean cuff pressures of groups A and B were 41.0+/-23.7 cmH2O and 23.7+/-16.5 cmH2O, respectively. The mean cuff pressure of group A were significantly higher than group B (p=0.002). The mean air volume that infused into the cuff of groups A and B were 8.6+/-2.6 ml and 7.6+/-2.4 ml, respectively, showing no significant difference (p=0.688). The proportion of the optimal cuff pressure (Normal range: 22-32 cmH2O) of group A (9/40, 22.5%) was higher than that of group B (3/40, 7.5%).
CONCLUSION
The range of air volumes and pressures for cuff inflation varied and it may not be possible to obtain the appropriate pressure using the LOR syringe technique. The endotracheal tube cuff pressure must be kept within the optimal range using a pressure monitor control inflator.