RT Journal Article
SR Electronic
T1 Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 165
OP 167
DO 10.1136/emj.2006.039933
VO 24
IS 3
A1 Catherine Mann
A1 Neil Parkinson
A1 Anthony Bleetman
YR 2007
UL http://emj.bmj.com/content/24/3/165.abstract
AB Background: Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar/1000 feet). Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30 cm H2O; critical perfusion pressure is 50 cm H2O. Methods: The change in dimensions of the inflated cuffs of a size 8 ETT and a size 5 LMA were measured with digital callipers at 1000 feet intervals in the unpressurised cabin of an Agusta 109 helicopter used by the Warwickshire and Northamptonshire Air Ambulance. Results: A linear expansion in cuff dimensions as a function of altitude increase was identified. For ETTs, a formula for removal of air from the cuff with increasing altitude was calculated and is recommended for use in aeromedical transfers. This is 1/17×1.1 = 0.06 ml/1000 foot ascent/ml initial cuff inflation. Conclusion: The data for LMA cuff expansion failed to show significant correlation with altitude change. Further work is required to determine a similar rule of thumb for LMA cuff deflation.