Evaluation of audible leak versus pressure volume loop closure for polyvinyl chloride cuff and polyurethane microcuff in endotracheal tube inflated with air

Cuff pressure of endotracheal tube (ETT) must be high enough to seal the trachea, and must be low enough to allow adequate perfusion of tracheal mucosa. Compared with polyvinyl chloride (PVC) cuffed tubes, polyurethane cuffed tubes protect more efficiently. Different methods of ETT cuff pressure maintenance in practice have been reported. We planned to compare ETT cuff pressure using different techniques in PVC and polyurethane microcuff tubes in a prospective randomized study. Eighty surgical patients between 16-65 years belonging to American Society of Anesthesiologists physical status I-III, scheduled for orotracheal intubation under general anaesthesia, were included. All enrolled patients were randomized into four groups (n = 20 per group), followed by corresponding treatments, including intubation by PVC ETT or polyurethane microcuff ETT and cuff inflation by auscultation of audible leak or pressure volume loop. Amount of air required to inflate cuff was more in polyurethrane tube as compared to polyvinyl tube. While comparing the two methods of cuff inflation, less volume of air was required in pressure volume loop method. We concluded that PVC cuff tube and polyurethane microcuff tube both are safe tubes used in adult patients. However, when inflated using same technique polyurethane microcuff tubes required larger volume to inflate cuff. Further, pressure generated in polyurethane microcuff tubes in much lower than PVC tubes. The study was approved by the Institutional Ethics Committee of Pt B D Sharma, PGIMS, Rohtak (No. IEC/Th/18/Anst15) on January 20, 2018 and registered with Clinical Trials Registry-India (registration No. CTRI/2019/01/017170) on January 18, 2019.