Endotracheal Tube Cuff Leaks.pdfVIP

Endotracheal Tube(ETT) Cuff Leaks Zhou Yang 2013.12.18 Endotracheal Tube Cuff Leaks ? Reported incidence in ICU: 5.9%~11%, in OR? ? A wide range of consequences can result if the leak is not properly managed from a bubbling noise to a life-threatening ventilatory failure. ? ETT replacement is the definitive solution, but often neither needed nor safe to perform. Causes 1 Consequences 2 Contents of ETT Cuff Leaks Management 3 Leaks around an intact cuff and/or inflation system Leaks due to a defective cuff and/or inflation system Causes of ETT Cuff Leaks Causes Causes of ETT Cuff Leaks(1) Leaks around an intact Cuff/Inflation System ? Cuff Underinflation ? Cephalad Migration of the ETT ? Inadvertent Intratracheal Placement of Gastric Tube ? Discrepancy Between ETT and Tracheal Diameters ? High Mean Airway Pressure Cuff Leaks caused by a cephalad migration of the ETT (partial tracheal extubation) Causes of ETT Cuff Leaks(2) Leaks due to a defective Cuff/Inflation System ? Inflation Valve ? Pilot Balloon ? Pilot Tubing ? Cuff Defects ? Clinicl consequences depend on the lost volume, patient characteristics, indication for ventilation and tracheal intubation, and type of surgery. Consequences of ETT Cuff Leaks(1) bubbling sound massive loss of tidal volume … … … ETT Cuff Leaks Consequences of ETT Cuff Leaks(2) Aspiration : a full blown aspiration or microaspiration Ventilator-associated Pneumonitis Gas Leakage : decrease the effective tidal volume Anesthetic gas Leakage: pollution inadequate depth of anesthesia Thoracic surgery : failure of lung separation Upper airway laser surgery : an airway fire Hypoxemia, Hypercarbia, and Respiratory failure ? Examination Management of ETT Cuff Leaks(1) bubbling noise and/or other signs of tidal volume loss assess the oxygenation check the machine quickly check the ETT depth chest auscultation direct laryngoscopy Management of ETT Cuff Leaks(2) ? Risk Stratif