Articles: intubation.
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A study was carried out in vitro to determine the minimum intracuff pressure needed to produce no-leak ventilation and prevent aspiration in Portex Profile and Searle Medical Sensiv endotracheal tubes. The mean pressures required to produced no-leak ventilation were 4.16 and 1.06 kPa respectively and the mean pressures at which aspiration occurred were 2.93 and 0.54 kPa respectively. The implications of these findings are discussed and recommendations are made regarding cuff specifications.
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A 3-year systematic study was made for subglottic and tracheal lesions of patients who had been intubated for more than 10 h (87 patients intubated for time periods ranging from 10 to 1,960 h). The radiological aspect of the lesions was studied and classified as tracheal stenosis, cartilage lesions and granulomas. The radiological analyses were performed by tracheography (14 cases), xerography, xerotomography (87 cases) and CT (2 cases). ⋯ The cuff, the tip of the endotracheal tube and the suction cannula were found to be responsible for the tracheal sequelae. A statistically significant correlation was found between the duration of the intubation and the severity of the tracheal lesions. The lesions, examined radiologically about a year after the intubation, were found to be stable.
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The authors constructed a D-shaped tracheal model with an elastic posterior wall, thus simulating normal tracheal anatomy more closely than previous models. The performance of 9-10 tracheal tube cuffs, of 2-3 different tube sizes (7.0-10.0 mm, ID), from six different manufacturers were tested in the model. Cuff residual volumes ranged from 1.78 to 27.35 ml. ⋯ There was no relationship between cuff brands in the wall pressure required to effect a seal in the model. The authors conclude that intratracheal tubes should have cuffs with large residual volumes. This would permit some latitude in tube size selection while ensuring that a seal could be achieved before the cuff is inflated to its residual volume.