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Adjusting tracheal tube cuff pressure

Kunstyr, Jan

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European Journal of Anaesthesiology (EJA): April 2015 - Volume 32 - Issue 4 - p 280
doi: 10.1097/EJA.0000000000000221
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I read with great interest the Invited Commentary by De Hert and De Baerdemaker1 that accompanied our recently published study.2

I do not agree with their conclusion that the control group patients in our study were not treated according to the rules of good clinical practice. It is true when De Hert and De Baerdemaker1 say that ‘it is striking to note that little information seems to be available on the incidence of silent aspiration secondary to insufficient sealing related to cuff pressure or other cuff properties’. I would like to add that until recently, almost nothing was known about the incidence of silent aspiration in patients undergoing surgery in deep hypothermic cardiac arrest.

Despite De Hert's and De Baerdemaker's assertion that adjusting tracheal cuff pressure is best practice, it is not actively carried out in the majority of operating rooms in Europe, and especially not in cardiac surgery and during cardiopulmonary bypass. I hope that by publishing these striking data, which represent a real clinical problem and not just a theoretical one, more clinicians will actually practise checking and inflating/deflating the cuff much more regularly during cardiac surgery than they currently do. I hope that best practice will become real-world medicine, and appreciate De Hert's and De Baerdemaker's assistance in pointing this out to readers of the journal.

Acknowledgements relating to this article

Assistance with the letter: none.

Financial support and sponsorship: none.

Conflicts of interest: none.


1. De Hert S, De Baerdemaker L. Randomised controlled trials. Are we looking at treatment effects or absence of good clinical practice in control groups? Eur J Anaesthesiol 2014; 31:450–451.
2. Rubes D, Klein AA, Lips M, et al. The effect of adjusting tracheal tube cuff pressure during deep hypothermic circulatory arrest: a randomised trial. Eur J Anaesthesiol 2014; 31:452–456.
© 2015 European Society of Anaesthesiology