The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

Abstract

The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH₂O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH₂O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.

Figure 1

Summary of the process of study selection for the current meta-analysis.

Figure 2

Forest plot comparing the risk of high cuff pressure after esophageal medical device insertion. CI confidence interval; M–H Mantel–Haenszel.

Figure 3

Meta-regression plot showing the association of patient characteristics (i.e., age, prevalence of male gender, and body mass index) with the risk of high cuff pressure.

Figure 4

Forest plot comparing the risk of high cuff pressure after esophageal medical device insertion in adults undergoing cardiac and non-cardiac surgery. CI confidence interval; M–H Mantel–Haenszel.

Figure 5

Forest plot for the comparison of changes in cuff pressure during esophageal medical device insertion. CI confidence interval; IV inverse variance.

Figure 6

Forest plot for the comparison of changes in cuff pressure after esophageal medical device insertion. CI confidence interval; IV inverse variance.

Figure 7

Meta-regression plot showing the association of patient characteristics (i.e., age, prevalence of male gender, and body mass index) with the mean difference in cuff pressure.

Figure 8

Forest plot for the comparison of changes in cuff pressure after esophageal medical device insertion in adults undergoing cardiac and non-cardiac surgery. CI confidence interval; M–H Mantel–Haenszel.