Effect of body position and head of bed angle on intra-abdominal and endotracheal tube cuff pressure in mechanically ventilated patients

authors:

avatar Elaheh Bahonar , avatar Rasool Ashrafi , avatar Mohsen Soleimani ORCID , *

Koomesh: Vol.24, issue 6; 807-817
published online: December 03, 2022
article type: Research Article
received: February 01, 2022
accepted: August 03, 2022

how to cite: Bahonar E, Ashrafi R, Soleimani M. Effect of body position and head of bed angle on intra-abdominal and endotracheal tube cuff pressure in mechanically ventilated patients. koomesh. 2022;24(6):e152793. 

Abstract

Introduction: Changing position is one of the typical nursing care in intensive care units. This study aimed to investigate the effect of body positioning on intra-abdominal pressure and endotracheal tube cuff pressure and their relationship with each other in patients undergoing mechanical ventilation Materials and Methods: This was a before-after clinical trial study performed on 70 patients over eight months. Eligible patients were placed in one of the positions of bed angle (flat, 30, and 45 degrees) and body position sideways toward an opposite direction to the mechanical ventilator. The intra-abdominal pressure and the endotracheal tube cuff pressure were measured with each change in body position and head of the bed. Data were analyzed at a significance level of 0.05. Results: Mean intra-abdominal pressure was different in positions (P<0.001). The mean intra-abdominal pressure at the flat angle was (7.4±0.49) CmH2O at the lowest and 45 degrees was (11.98±0.45) CmH2O at the highest. The mean intra-abdominal pressure in the supine position was significantly lower than in other positions (P<0.001). The endotracheal cuff pressure was significantly higher in lying down on the opposite side of the ventilator than in other positions (P<0.001). There is no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure (P=0.15). Conclusion: The results showed that at the flat angle and opposite direction to the mechanical ventilator, the tube cuff pressure was maximal and at an angle of 45° and the position of the opposite side of the mechanical ventilator, the intra-abdominal pressure was the highest. Although there was no significant relationship between intra-abdominal pressure and endotracheal tube cuff pressure, when lying on the opposite side of the mechanical ventilator, intra-abdominal pressure and endotracheal tube cuff pressure were abnormally high. Therefore, it is recommended to avoid the patient in this situation.

References

  • 1.

    Hunt L, Frost SA, Newton PJ, Salamonson Y, Davidson PM. A survey of critical care nurses' knowledge of intra-abdominal hypertension and abdominal compartment syndrome. Aust Crit Care 2017; 30: 21-27.

  • 2.

    Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I Definitions Inte Care Med 2006; 32: 1722-1732.

  • 3.

    Samimian S, Ashrafi S, Mohammadi TK, Yeganeh MR, Ashraf A, Hakimi H, et al. The correlation between head of bed angle and intra-abdominal pressure of intubated patients; a pre-post clinical trial. Arch Aca Emer Med 2021; 9: e23.

  • 4.

    Mahran GS, Abd-Elshafy SK, El Neem MM, Sayed JA. The effect of reference position versus right lateral position on the intra-abdominal pressure in mechanically ventilated patients. J Nur Edu Prac 2018; 8: 93-98.##https://doi.org/10.5430/jnep.v8n6p93.

  • 5.

    Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment: intra-abdominal hypertension and the abdominal compartment syndrome. Curr Opin Crit Care 2016; 22: 174-185.

  • 6.

    Morejn DS, Barbeito TO. Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study. Ann Inte Care 2012; 2: S22.

  • 7.

    McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med 2012; 367: 2233-2239.

  • 8.

    Holodinsky JK, Roberts DJ, Ball CG, Blaser AR, Starkopf J, Zygun DA, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Cri Care 2013; 17: 1-5.

  • 9.

    Murcia-Sez IM, Sobrino-Hernandez ML, Garca-Lopez F, Crcoles-Gonzlez V, Corts-Monedero JL, Tendero-Egea A, et al. Usefulness of intra-abdominal pressure in a predominantly medical intensive care unit. J Cri Care 2010; 25: 175.e1-e6.

  • 10.

    Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogu S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: A randomized trial. Lancet 1999; 354: 1851-1858.

  • 11.

    Telias I, Katira BH, Brochard L. Is the prone position helpful during spontaneous breathing in patients with COVID-19? Jama 2020; 323: 2265-2267.

  • 12.

    Evans D. The use of position during critical illness: current practice and review of the literature. Aust Crit Care 1994; 7: 16-21.

  • 13.

    Alan N, Khorshid L. The effects of different positions on saturation and vital signs in patients. Nurs Crit Care 2021; 26: 28-34.

  • 14.

    Samimian S. Comparison the change of IAP at 0, 15, 30 degrees for the head of bed in patients admitted at critical care units in Rasht In: Supervisor: Khaleghdoost T ASA. Gilan Univ Med Sci (Persian). 2012; 69: 30-37.##.

  • 15.

    McBeth PB, Zygun DA, Widder S, Cheatham M, Zengerink I, Glowa J, et al. Effect of patient positioning on intra-abdominal pressure monitoring. Amer J Surg 2007; 193: 644-647.

  • 16.

    Yi M, Leng Y, Bai Y, Yao G, Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. J Crit Care 2012; 27: 222.e1-e6.

  • 17.

    Gray S, Christensen M, Craft J. The gastro-renal effects of intra-abdominal hypertension: Implications for critical care nurses. Inte Crit Care Nurs 2018; 48: 69-74.

  • 18.

    Ni L, Fan Y, Bian J, Deng X, Ma Y. Effect of body mass on oxygenation and intra-abdominal pressure when using a jackson surgical table in the prone position during lumbar surgery. Spine 2018; 43: 965-970.

  • 19.

    Balogh Z, De Waele JJ, Kirkpatrick A, Cheatham M, D'Amours S, Malbrain M. Intra-abdominal pressure measurement and abdominal compartment syndrome: The opinion of the World Society of the Abdominal Compartment Syndrome. Crit Care Med 2007; 35: 677-678.

  • 20.

    Cresswell AB, Jassem W, Srinivasan P, Prachalias AA, Sizer E, Burnal W, et al. The effect of body position on compartmental intra-abdominal pressure following liver transplantation. Ann Inte Care 2012; 2.

  • 21.

    Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Aml J Crit Care 2014; 23: e1-e8.

  • 22.

    Kim E, Kim HC, Lim YJ, Kim CH, Sohn S, Chung CK, et al. Comparison of intra-abdominal pressure among 3 prone positional apparatuses after changing from the supine to the prone position and applying positive end-expiratory pressure in healthy euvolemic patients: a prospective observational study. J Neurosurg Anesth 2017; 29: 14-20.

  • 23.

    Soleimani M, Rajabi MR, Fakhr movahedi A, Ghods A A. Effects of endotracheal tube cuff pressure regulation with minimal occlusion volume on incidence of ventilator-associated pneumonia. Koomesh 2014; 15: 168-175. (Persian).

  • 24.

    Alcan AO, van Giersbergen MY, Dincarslan G, Hepcivici Z, Kaya E, Uyar M. Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients. Aust Crit Care 2017; 30: 267-272.

  • 25.

    Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emer Med 2006; 24: 139-143.

  • 26.

    Terashima H, Sakurai T, Takahashi S, Saitoh M, Hirayama K. Postintubation tracheal stenosis; problems associated with choice of management. Japan J Thoraci Surg 2002; 55: 837-842.

  • 27.

    Pelc P, Prigogine T, Bisschop P, Jortay A. Tracheoesophageal fistula: case report and review of literature. Acta Oto-rhino-laryng Belgica 2001; 55: 273-278.

  • 28.

    Soleimani M. Effect of changing position on endotracheal tube cuff pressure in patients with mechanical ventilation. Tehran Univ Med J 2018; 76. (Persian).

  • 29.

    Dullenkopf A, Schmitz A, Frei M, Gerber A, Weiss M. Air leakage around endotracheal tube cuffs. Euro J Anaesth 2004; 21: 448-453.##https://doi.org/10.1097/00003643-200406000-00006.

  • 30.

    Yildirim ZB, Uzunkoy A, Cigdem A, Ganidagli S, Ozgonul A. Changes in cuff pressure of endotracheal tube during laparoscopic and open abdominal surgery. Surg Endosc 2012; 26: 398-401.

  • 31.

    Vasquez DG, Berg-Copas GM, Wetta-Hall R. Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure. J Surg Res 2007; 139: 280-285.

  • 32.

    Cheatham ML, De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med 2009, 37: 2187-2190.

  • 33.

    De Keulenaer B, De Waele J, Powell B, Malbrain M. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Inte Care Med 2009; 35: 969-975.

  • 34.

    Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, et al. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. J Clin Aneasth 2013; 25: 28-31.

  • 35.

    Kim D, Jeon B, Son JS, Lee JR, Ko S, Lim H. The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head. Korean J Aneasth 2015; 68: 27.

  • 36.

    Wu CY, Yeh YC, Wang MC, Lai CH, Fan SZ. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position. BMC Aneasth 2014; 14: 1-6.

  • 37.

    Komasawa N, Mihara R, Imagawa K, Hattori K, Minami T. Comparison of pressure changes by head and neck position between high-volume low-pressure and taper-shaped cuffs: A randomized controlled trial. Bio Med Rese Intern 2015; 2015.

  • 38.

    Kako H, Krishna SG, Ramesh AS, Merz MN, Elmaraghy C, Grischkan J, et al. The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population. Pedia Anesth 2014; 24: 316-321.