Minimal occlusive volume is a safe and effective method for adjusting cuff pressure in mechanically ventilated patients

ABSTRACT

The ideal cuff pressure (P_cuff) must prevent microaspiration of oropharyngeal secretions due to air leakage and avoid injury to the tracheal mucosa. Usually, monitoring consists of a manometer to keep the P_cuff between 20 and 30cmH₂O. The minimal occlusive volume (MOV) method minimally inflates the cuff using a syringe so that no leakage occurs. This study aims to evaluate the ability of the minimal occlusive method to individualize the P_cuff adjustment in mechanically ventilated patients. Cross-sectional prospective study with 25 adult patients with more than 48 hours of mechanical ventilation. Cuff pressure was measured at two moments: initial and by MOV. The prevalence of P_cuff outside the normal range was 76%. Leakage in the initial measurement occurred in 9 patients, 4 of whom were within the reference values. The other 5 patients presented P_cuff<20cmH₂O. In the adjustment by the MOV method, all patients presented P_cuff at the limit of normality. Patients without leakage with P_cuff>30cmH₂O had a reduction when adjusted for MOV (45.4±9.6 against 28.5±1.6cmH₂O; p<0.001). We can conclude that the minimal occlusive volume method was able to individualize the P_cuff within the reference values in all patients.

Keywords:
Pneumonia, Ventilator-Associated; Airway Management; Intensive Care Units