Evaluation of an Artificial Airway Cuff Maintenance Device

Background:

Ensuring the use of safe ETT cuff pressures may prevent trauma to the trachea and reduce risk of aspiration. We tested the Hamilton Intellicuff Monitoring System on a Hamilton G5 ventilator (Hamilton Medical, Bonaduz, Switzerland) to determine if it accurately read and maintained pressures. The null hypothesis is that there will be no difference between the Intellicuff pressures and the control.

Methods:

A SmartLab Series 1140 (Hans Rudolph, Shawnee, KS) was used to measure airway cuff pressure in real time. We used a mannequin (Laerdal Airway Management Trainer, Wappingers Falls, New York) to simulate a patient airway and intubated it with an 8.5 mm I.D. endotracheal tube (Intermediate Hi-Lo, Mallinckrodt, Dublin, Ireland) that was inflated using the Intellicuff system. We let the system run for 3 seconds to prime all of the connecting tubing and reduce the possibility of dead space measurement. We ran this all through a closed system consisting of the Hamilton ventilator, the tubing from the Intellicuff, a 3-way stopcock, tubing from the SmartLab and an ETT. After each run we disassembled all connections, deflated the ETT cuff, turned off the Hamilton, and zeroed the SmartLab sensor. This procedure was repeated four times for each pressure starting at 15 cm H₂O, then increasing to 25 cm H₂O, and finally 45 cm H₂O.

Results:

The measured pressure reading at 15 cm H₂O was different than the control (P = .01). There was no difference in pressure at settings of 25 and 45 cm H₂O (P = .18) and (P = .09) respectively. Mean pressure readings at each of the three Intellicuff set inflation points were: 15.271 cm H₂O, 25.444 cm H₂O, and 46.074 cm H₂O.

Conclusions:

The Hamilton Intellicuff will read cuff pressures at 25 cm H₂O and 45 cm H₂O accurately. While there was a statistical difference between the Intellicuff and the control at 15 cm H₂O, more research needs to be conducted to determine if our findings are clinically significant. With these findings, the Hamilton Intellicuff is a tool that can be used to ensure that safe pressures are being delivered to the cuff of the artificial airway, which can prevent trauma to the trachea and reduce aspiration risk.

Hamilton Intellicuff Pressure Accuracy