The purpose of this study is to investigate that the change of cuff pressure during early mobilization of ICU patients.
Nineteen patients were evaluated while receiving mechanical ventilation via an oral endotracheal tube. there were thirty-four early mobilization sessions in the nineteen patients from June 2019 to March 2020. The main diagnoses of patients were after cardiovascular surgery, gastrointestinal surgery, acute respiratory failure, and acute heart failure. As for mechanical ventilator settings, all session were evaluated in CPAP + PSV mode, PEEP level less than 10cmH₂O, PS level less than 10cmH₂O, FiO₂ less than 0.6. All early mobilization were provided by two physical therapists and Nurse. The one of the medical staff managed the position of patient head, neck and endotracheal tube from behind the patient. Three-way stopcock between pilot balloon and cuff pressure gauge was adopted for management of cuff pressure. The point of evaluation cuff pressure and various parameters were evaluated in baseline (supine to head up thirty degree), just after sitting, three minutes after sitting, five minutes after sitting, just after standing, three minutes after standing, five minutes after standing. Furthermore, tidal volume, minutes volume, respiratory rate, the volume of leak, inspiratory flow rate, expiratory flow rate and heart rate. Multiple comparison procedure in EZR adopted for statistical analysis.
The cuff pressure decreased with the change of posture and with the amount of time that elapsed. There was a statistically significant change in the difference in cuff pressure between baseline and three minutes after sitting (p=0.005), and in baseline and five minutes after sitting (p=0.001), and in baseline and light in standing (p=0.0003), and in baseline and three minutes after standing (p=0.0003), and in baseline and five minutes after standing (p=0.005). There were not statistically significant changes in the other parameters. However, Respiratory rate and heart rate tend to be high frequency rate in postural change from supine to sitting and standing.
In this research, the cuff pressure decreased during early mobilization. This may be due to the activation of the sympathetic nervous system, changes in breathing patterns, and the influence of head and neck posture on the reduction of cuff pressure during early mobilization.
It was suggested that it is important to adjust cuff pressure at postural change and time elapsed, and the use of automatic cuff monitor is one of the important managements for safe early mobilization.
Mechanical ventilation
Cuff pressure
