Achieving an optimal Endotracheal Tube Pressure: Comparison of Loss of Resistance and Pilot Balloon Techniques

Abstract

Background: Inappropriate estimation of endotracheal tube pressure can result in significant harm to the patient, and the use of a  manometer is the only reliable way of ensuring an optimal pressure range (20- 30cmH2O). In the absence of a manometer, the Pilot  balloon palpation (PBP) technique is commonly employed in our environment.

Aim: This study compared the accuracy of a newer  method of ETTc infiation called passive release technique using loss of resistance (LOR) syringe with the PBP technique in determining  optimal ETTc pressure.

Methods: One hundred and eighty ASA I and II patients, aged 18 – 65 years, scheduled for elective procedures  under general anesthesia with ETT were randomized into 2 groups with one group having their cuff pressures measured by pilot balloon  palpation (PBP) and the other using a loss of resistance syringe (LOR). The cuff pressure was then measured in each group using a  sensitive manometer.

Results: The mean ETTc pressure was found to be significantly higher in the PBP group than in the LOR group  (64.28 ± 31.12 and 29.64 ± 11.68; p= 0.0001). The LOR technique was found to be significantly more accurate in ETTc pressure estimation  than the PBP techniques (59.3 vs 27.8%; p = 0.0001).

Conclusion: Passive release technique using LOR was found to be significantly more  accurate compared to PBP in optimal ETTc pressure estimation.