Infusion Pump for Managing Endotracheal Tube Cuff Incompetence

To the Editor: Maintaining adequate endotracheal tube (ETT) cuff pressure is crucial during the intraoperative period, especially in a surgical procedure on the head and neck where replacing a defective tube with a new one is hardly feasible (1). We describe a novel method of maintaining adequate cuff pressure in a patient whose endotracheal cuff was inadvertently damaged during surgery. A patient with ankylosing spondylitis was scheduled for discectomy for cervical prolapsed intervertebral disk. His airway examination was remarkable for an interincisor distance of 4 cm, normal dentition, and reduced mentosternal distance of 5 cm due to fixed flexion deformity of neck. We intubated his trachea on the third attempt with a 7.5-mm ID cuffed Portex ETT. Thirty minutes after the start of surgery, we noticed a leakage in the cuff. We reinflated it with air, but the leak recurred. We excluded the pilot balloon and the tubing as sources of the leak. Because we had adequately documented cuff function preoperatively, we assumed that repeated intubation attempts might have caused a microperforation in the ETT. We assembled an infusion pump with a 50-mL air syringe, connected to the cuff’s air inlet and a pressure monitoring device (Fig. 1). We inflated the ETT with enough air to maintain a pressure of 20 cm H2O, and maintained this pressure by a continuous infusion of air. A continuous air flow of 5–10 mL h−1 kept the cuff pressurized. We were easily able to adjust the infusion rate to maintain a proper cuff seal, and the case was completed without incident.Figure 1.: Infusion pump to regulate endotracheal tube cuff pressure.Yatindra K. Batra, MD, MNAMS, FAMS S. Rajeev, MD Department of Anaesthesia and Intensive Care Unit Postgraduate Institute of Medical Education and Research Chandigarh, India [email protected]

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