Articles: intubation.
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Anaesth Intensive Care · May 1977
Efficacy of high volume low pressure cuffs in preventing aspiration.
The incidence of aspiration in patients with indwelling high volume, low pressure cuff endotracheal and tracheostomy tubes was assessed. A simple technique to routinely determine the correct inflation pressure of cuffs is recommended.
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Eighteen brands of cuffed endotracheal tubes, including those with the new low pressure cuffs, were evaluated and compared. Experiments were performed in vitro on excised dog tracheae to measure the mucosal pressure exerted by the inflated cuffs. Pressure was measured directly with a mechanical sensor. ⋯ The data showed that, when inflated sufficiently to seal within the trachea, stiff cuffs reduced blood flow more than compliant cuffs. With all cuffs, blood flow was reduced more at the mucosa than at deeper regions of the tracheal wall. It was concluded that for clinical use, compliant cuffs are preferable to stiff cuffs because they should cause less ischemia.
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As a result of increased use of prolonged endotracheal intubation, complications of intubation are now being seen more often. Stenosis of the airway may develop at the level of the glottic or subglottic larynx, or in the trachea. Discussions of management do not always distinguish clearly between laryngeal stenosis and tracheal stenosis. ⋯ Endoscopic management can be successful in many cases if it is started early enough, and repeated as often as is necessary. The earlier it is begun, the better the results will be. 3. Indwelling stents which are extremely valuable in laryngeal stenosis from external trauma, may not be as useful in stenosis from endotracheal tube trauma.