The application of reinforced endotracheal tubes with pressure indicators in preventing postoperative airway-related complications in neurosurgical patients: a randomized controlled study

BACKGROUND: Excessive cuff pressure can lead to complications associated with endotracheal intubation. This study aims to compare the effects of cuff inflation guided by a pressure indicator versus the tactile estimation method on postoperative airway-related complications in neurosurgical patients. METHODS: This study employed a prospective, randomized, double-blind, controlled design. Blinding was implemented for the subjects and data collectors. Subjects were randomly divided into two groups. The intervention group used tracheal tubes with pressure indicators. The control group used standard reinforced tracheal tubes. The primary outcome measure was the score of tracheal mucosal injury in two groups of subjects under bronchoscopy assistance with extubation. Secondary outcome measures included: (1) the incidence of tracheal mucosal injury assessed by bronchoscopy at the time of extubation; (2) the incidence of blood-stained cuff during extubation; (3) the incidence and severity of sore throat, and the incidence of hoarseness, blood-stained sputum, and coughing at 1 h and 24 h post-extubation. RESULTS: The intervention group demonstrated a significantly lower tracheal mucosal injury score before extubation compared to controls (1.4 ± 0.274 vs. 2.7 ± 0.335; P = 0.009). There were no significant differences in immediate post-extubation complications or short-term (1-hour) postoperative symptoms. Notably, while the majority of 24-hour post-extubation outcomes remained comparable between groups, the intervention group exhibited significantly reduced sore throat severity at this timepoint (P = 0.044). CONCLUSION: The use of tracheal tubes with pressure indicators to control intraoperative cuff pressure could reduce postoperative airway mucosal damage in neurosurgical patients and alleviated post-extubation pharyngeal pain after 24 h. TRIAL REGISTRATION: ChiCTR2200065315, first registered on 02/11/2022. The study was retrospectively registered.