Comparison of Pressure Volume Loop Closure with Just to Seal Technique to guide Endotracheal Tube Cuff Inflation - A Prospective Randomized Controlled Trial

Objective: Several methods of endotracheal cuff (ETT) inflation methods were investigated to ensure proper cuff inflation to avoid short, and long term airway morbidities. Pressure Volume Loop (PV-L) closure was found to be a new technique to guide ETT cuff inflation with a lower cuff pressures. Hence, we assessed whether PV-L was a useful guide in inflating the ETT with adequate cuff pressure when compared to Just to Seal (JS) technique. Method: A prospective randomized double-blinded study was done with eighty-four patients undergoing surgeries under general anesthesia using endotracheal tubes. The ETT cuffs were inflated using PV-L closure in PV-L group and using stethoscope in JS group. The cuff pressure was measured as the primary outcome of the study. The cuff volume, postoperative sore throat, cough and hoarseness of voice were assessed as secondary outcomes. Results: In our study, PV-L group had statistically significantly lower post-intubation (24.54.97 cm of H 2 O in PV-L group, 28.66.39 cm of H 2 O in group JS, p-0.002) and pre-extubation cuff pressures (24.94.923 cm of H 2 O in Group PV-L, 29.05.624 cm of H 2 O in Group JS, p-0.001) when compared with the JS method. Conclusion: Pressure Volume Loop-guided endotracheal tube cuff inflation was an effective way to seal the airway with lower cuff pressures and was associated with a lower incidence of postoperative ETT cuff-related complications when compared with Just to Seal method.