Flovent Inhaler

- High-volume, Low-pressure Cuffs (14)

From the foregoing discussion it follows that as long as resting cuff diameter is greater than that of the trachea at maximal expansion, cuff length is the primary factor in maintaining a selfsealing effect in the face of rising airway pressure (or, all else being equal, the longer cuff wins).
The confounding problem of excessive intracuff pressure, which damages the trachea but is necessary to provide a seal at high PIP, has not been resolved. We recently determined that 55 percent of a group of mechanically ventilated SICU patients required cuff inflation pressures in excess of 25 mm Hg despite the use of high-volume, low-pressure cuffs (unpublished data, E.A. Radson, T.E. Banner, M.J. Banner, et al). This observation and the report of Stauffer et al suggest that current cuff design is inadequate. When high PIP is necessary during mechanical ventilation, tracheal damage is predictable, even with meticulous attention to cuff inflation. Such requirements are incompatible with maintenance of low intracuff and CT pressures if satisfactory ventilation is to be maintained. Intermittent cuff inflation synchronized with the ventilators inspiratory phase, with partial deflation during exhalation, can resolve some of these problems. The ultimate solution awaits a new cuff design.

June 21, 2013 Cardiac function
Tags: airway pressure ischemic tracheal complications tracheal stenosis