• Tae Kyong Kim, Jeong Jin Min, Jeong-Hwa Seo, Yong-Hun Lee, Jae-Woo Ju, Jae-Hyon Bahk, Deok Man Hong, and Yunseok Jeon.
• 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).
• Eur J Anaesthesiol. 2015 Aug 1; 32 (8): 549-54.

BackgroundExcessive 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.ObjectiveTo 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).DesignA prospective, observational study.SettingSingle-centre trial, study period from October 2013 to January 2014.PatientsForty-four adult patients scheduled for elective cardiothoracic surgery requiring intraoperative TOE monitoring.InterventionsAfter 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.Main Outcome MeasuresThe primary endpoint was steady-state tracheal cuff pressure after insertion of the TOE probe.ResultsMedian (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).ConclusionInsertion 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.Trial RegistrationClinicaltrials.gov identifier: NCT02034643.

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