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Effect of subglottic air insufflation on subglottic pressure during swallowing

Abstract:

Objective: To determine whether there are differences between subglottic pressure during swallowing with and without air insufflation via a subglottic catheter in tracheostomized patients. Design: A prospective, randomized cross-over study was made. Setting: Adult Intensive Care Units. Participants: Patients requiring mechanical ventilation and tracheostomy with a subglottic catheter, and with tolerance to deflation of the balloon and a speaking valve placed over the opening of the tracheostomy tube. Interventions: Subglottic pressure was measured during swallowing of a thickened solution with and without the delivery of airflow through the subglottic catheter. Main variable: Subglottic pressure during swallowing. Results: Twelve out of 14 patients showed higher subglottic pressurevalues during swallowing with air insufflation. Two patients showed no differences between both conditions. Median (Med) values of subglottic pressure for the first, second and third swallow were 5, 4 and 4.5cmH2O (Med 4.5cmH2O) without air insufflation, and 8, 5.5 and 7.5cmH2O (Med 5.5cmH2O) with air insufflation, respectively (Wilcoxon, Z=-3.078; p=.002). Conclusion: In a group of tracheostomized patients, air insufflation via a subglottic catheter increased subglottic pressure levels measured during swallowing. © 2012 Elsevier España, S.L. and SEMICYUC.