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Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanically ventilation

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Abstract
Background: In order to avoid microaspiration and tracheal injury, the target for endotracheal tube cuff pressure is 20 to 30 cm H2O. Objective: To assess the effect of changes in body position on cuff pressure in adult patients. Methods: Twelve orally intubated and sedated patients received neuromuscular blockers and were positioned in a neutral starting position (backrest, head-of-bed elevation 30 degrees, head in neutral position) with cuff pressure at 25 cm H2O. Then, 16 changes in position were performed: anteflexion head, hyper extension head, left and right lateral flexion of head, left and right rotation of the head, semirecumbent position (head-of-bed elevation 45), recumbent position (head-of-bed elevation 10), horizontal backrest, Trendelenburg position (10), and left and right lateral positioning over 30, 45, and 90. Once a patient was correctly positioned, cuff pressure was recorded during an end-expiratory ventilatory hold. The pressure observed was compared with the cuff pressure at the starting position. Values outside the target range (20-30 cm H2O) were considered clinically relevant. Results: A total of 192 measurements were performed (12 subjects x 16 positions). A significant deviation in cuff pressure occurred with all 16 changes (P < .05). No pressures were less than the lower limit (20 cm H2O). Pressures were greater than the upper limit (30 cm H2O) in 40.6% of the measurements. In each position, the upper target limit was exceeded at least once. Within-patient variability was substantial (P = .02). Conclusion: Simple changes in patients' positioning can result in potentially harmful cuff pressures.
Keywords
SUCTIONING TECHNIQUES, AIRWAY MANAGEMENT-PRACTICES, INTRACUFF PRESSURES, STANDARD TECHNIQUES, RISK-FACTORS, PNEUMONIA, CARE, INTUBATION, TRACHEA, LESIONS

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Chicago
Lizy, Christelle, Walter Swinnen, Sonia Labeau, Jan Poelaert, Joel Dulhunty, Dirk Vogelaers, Koenraad Vandewoude, and Stijn Blot. 2014. “Cuff Pressure of Endotracheal Tubes After Changes in Body Position in Critically Ill Patients Treated with Mechanically Ventilation.” American Journal of Critical Care 23: e1–e8.
APA
Lizy, C., Swinnen, W., Labeau, S., Poelaert, J., Dulhunty, J., Vogelaers, D., Vandewoude, K., et al. (2014). Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanically ventilation. AMERICAN JOURNAL OF CRITICAL CARE, 23, e1–e8.
Vancouver
1.
Lizy C, Swinnen W, Labeau S, Poelaert J, Dulhunty J, Vogelaers D, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanically ventilation. AMERICAN JOURNAL OF CRITICAL CARE. 2014;23:e1–e8.
MLA
Lizy, Christelle, Walter Swinnen, Sonia Labeau, et al. “Cuff Pressure of Endotracheal Tubes After Changes in Body Position in Critically Ill Patients Treated with Mechanically Ventilation.” AMERICAN JOURNAL OF CRITICAL CARE 23 (2014): e1–e8. Print.
@article{4239335,
  abstract     = {Background: In order to avoid microaspiration and tracheal injury, the target for endotracheal tube cuff pressure is 20 to 30 cm H2O. 
Objective: To assess the effect of changes in body position on cuff pressure in adult patients. 
Methods: Twelve orally intubated and sedated patients received neuromuscular blockers and were positioned in a neutral starting position (backrest, head-of-bed elevation 30 degrees, head in neutral position) with cuff pressure at 25 cm H2O. Then, 16 changes in position were performed: anteflexion head, hyper extension head, left and right lateral flexion of head, left and right rotation of the head, semirecumbent position (head-of-bed elevation 45), recumbent position (head-of-bed elevation 10), horizontal backrest, Trendelenburg position (10), and left and right lateral positioning over 30, 45, and 90. Once a patient was correctly positioned, cuff pressure was recorded during an end-expiratory ventilatory hold. The pressure observed was compared with the cuff pressure at the starting position. Values outside the target range (20-30 cm H2O) were considered clinically relevant. 
Results: A total of 192 measurements were performed (12 subjects x 16 positions). A significant deviation in cuff pressure occurred with all 16 changes (P {\textlangle} .05). No pressures were less than the lower limit (20 cm H2O). Pressures were greater than the upper limit (30 cm H2O) in 40.6\% of the measurements. In each position, the upper target limit was exceeded at least once. Within-patient variability was substantial (P = .02). 
Conclusion: Simple changes in patients' positioning can result in potentially harmful cuff pressures.},
  author       = {Lizy, Christelle and Swinnen, Walter and Labeau, Sonia and Poelaert, Jan and Dulhunty, Joel and Vogelaers, Dirk and Vandewoude, Koenraad and Blot, Stijn},
  issn         = {1062-3264},
  journal      = {AMERICAN JOURNAL OF CRITICAL CARE},
  language     = {eng},
  pages        = {e1--e8},
  title        = {Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanically ventilation},
  url          = {http://ajcc.aacnjournals.org/content/23/1/e1},
  volume       = {23},
  year         = {2014},
}

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