Pressure changes in tapered and cylindrical shaped cuff after extension of head and neck: A randomized controlled trial

Background: The proper cuff pressure of endotracheal tube (ET) plays an important role in sealing the airway and preventing airway complications during mechanical ventilation. The ET cuff shape affects the cuff pressure after positional change.

Aim: To investigate cuff pressure between tapered and cylindrical cuff after extension of head and neck during nasal endotracheal intubation.

Methods: In a randomized clinical trial, 52 patients were randomized to one of two groups: cylindrical cuff or Tapered cuff. Cuff pressure with 22 cmH₂O was applied to patients in the neutral position. After extension of head and neck, the cuff pressure was evaluated again and readjusted to 22 cmH₂O. In addition, the extent of cephalad migration of ET tip was assessed and postoperative airway complications such as sore throat, and hoarseness were measured.

Results: The cuff pressure was higher in the tapered cuff (28.7 ± 1.0 cmH₂O) than in the cylindrical cuff (25.5 ± 0.8 cmH₂O) after head and neck extension (P < 0.001). The extent of cephalad migration of tube tip was greater in TaperGuard ET (18.4 ± 2.2 mm) than in conventional ET (15.1 ± 1.2 mm) (P < 0.001). The incidence of postoperative airway complications was comparable between two groups.

Conclusion: After head and neck extension, the cuff pressure and the extent of cephalad migration of ET was greater in tapered cuff than in cylindrical cuff during nasal intubation, respectively.