PubMed · 17071411
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Ed Macdonald. We are a SAFE program because.... https://doi.org/10.1016/j.amj.2006.06.004
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INTRODUCTION: Cuffed endotracheal tubes are used to prevent gas leak and also pulmonary aspiration in ventilated patients. The pressure exerted on the tracheal wall is similar to intracuff pressure. The perfusion pressure for the tracheal mucosa is 40 cm H(2)O. Cuff pressures greater than 40 cm H(2)O may cause various ischemic changes and complications. High cuff pressures have also been implicated in postoperative sore throat and nonischemic complications. Postintubation endotracheal tube cuff pressures are not routinely measured in the ED or prehospital setting. The time spent in these settings may be long enough for pressure-induced tracheal mucosal injury to occur. The purpose of this study is to assess cuff pressures in intubated patients before aeromedical transport. METHODS: All intubated patients transported by an aeromedical transport program during a 3-month period were included in this study. Patients were intubated either by helicopter physicians or before helicopter arrival at the referring hospital or by ambulance personnel. Cuff pressure was measured using a manometer (Cuffpressure, Posey Co, USA). This measurement was recorded, and correction was performed, if necessary, to achieve a cuff pressure of 14 to 27 cm H(2)O while preventing an air leak. Data were analyzed for the distribution of intracuff pressures and incidence of elevated pressure on first measurement and the need for correction. RESULTS: There were 62 patients in this study. The mean first recorded pressure was 63 +/- 34 cm H(2)O. Initial cuff pressures were greater than 40 cm H(2)O in 36 (58%) patients and required correction. CONCLUSIONS: In this study, most cuff pressures exceeded safe pressure and required correction. Measurement of intracuff pressure is a simple and inexpensive procedure and should be done whenever a patient is intubated, in either the prehospital or hospital setting, because this may reduce long-term morbidity.
OBJECTIVE: Acute respiratory failure can make long distance transport by air extremely difficult. Despite pressurised cabins, the pressure will fall to about three quarters of one atmosphere, and the oxygen partial pressure will fall proportionally. Interventional lung assist (iLA) is a well documented treatment in the critical care unit, but has not been evaluated scientifically in long range aero-medical evacuation. The present animal study was performed to test the feasibility of treating lung failure with iLA during intercontinental air evacuation in a military setting. METHODS: Eight adult female pigs were cannulated in the right axillary artery and the right jugular vein. An arterio-venous iLA device (Novalung) was connected. The ventilator was adjusted to below half of the needed minute volume before the use of iLA. The animals went through different modalities of transportation in ambulances, helicopters and aircraft. Two of the pigs were tested in a hypobaric chamber, and the remaining two animals underwent a 7.5 h intercontinental transportation from Denmark to Greenland in a Hercules C130J transport airplane. RESULTS: It was possible to maintain physiological PaCO(2) and PaO(2) in normal flight altitudes with iLA. Compared to pump-driven ECMO systems iLA is safer and more efficient. The current study demonstrates the feasibility of iLA during military aero-medical evacuation.