Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

INTRODUCTION: Several methods of endotracheal cuff (ETT) inflation were evaluated to ensure proper cuff inflation to avoid short and long term airway morbidities. Pressure Volume Loop (PV-L) closure was found to be a new technique to guide ETT cuff inflation with a lower cuff pressures. Hence, we assessed whether PV-L was a useful guide in inflating the ETT with adequate cuff pressure when compared to Just to Seal (JS) technique.
METHODS: A prospective randomized double blinded study was done on eighty four patients undergoing surgeries under general anaesthesia using endotracheal tubes. The ETT cuffs were inflated using PV-L closure in PV- L group and using stethoscope in JS group. The cuff pressure was measured as primary outcome of the study. The cuff volume, post operative sore throat, cough and hoarseness of voice were assessed as secondary outcomes.
RESULTS: In our study, PV-L group had statistically significantly lower post intubation cuff pressure (24.5 ± 4.97 cm H2O in PV-L group, 28.6 ± 6.39 cm H2O in group JS, p = 0.002) and pre extubation cuff pressure (24.9 ± 4.923 cm H2O in Group PV-L, 29.0 ± 5.624 cm H2O in Group JS, p = 0.001) when compared with the JS method.
DISCUSSION AND CONCLUSION: Pressure Volume Loop-guided endotracheal tube cuff inflation was an effective way to seal the airway with lower cuff pressures and was associated with a lower incidence of postoperative ETT cuff related complications when compared with Just to Seal method.