Comparison of the loss of resistance syringe to pilot balloon palpation in achieving the recommended endotracheal cuff pressure of Filipino patients in a tertiary private hospital: a cross-over randomized controlled trial

Abstract

ABSTRACT Objectives: This study compared the effectiveness of the loss of resistance (LOR) syringe and pilot balloon palpation (PBP) methods in delivering adequate air volume to the endotracheal cuff of Filipino patients during intubation under general anesthesia. Materials and Methods: This was a crossover randomized controlled study involving intubated patients conducted in St. Luke’s Medical Center from August to September 2022. There were 68 patients enrolled. Two methods to estimate the endotracheal cuff pressures were used for each patient—the LOR syringe LOR method and the PBP method. The patients were randomized into 1:1 ratio allocation to one of the two sequences—LOR–PBP sequence and PBP–LOR sequence. Endotracheal cuff air volume for each method was recorded and classified as adequate if within the air volume range that achieved 20–30 cmH2O based on the cuff manometer. Results: The median lower and upper range of adequate endotracheal cuff air volume were 7 and 8 mL, respectively. The median air volume was 7 mL (range: 6–9 mL) and 8 mL (range: 6–9 mL) when PBP and LOR syringe methods were used, respectively. The proportion of patients who received adequate air volume was significantly higher when the LOR syringe was used (97.06%, 66/68) compared to the PBP method (48.53%, 33/68) (P = 0.002). None of the participants reported adverse effects for both methods. Conclusions: The LOR syringe method was superior to the PBP method in delivering adequate endotracheal cuff air volume. This method is a viable option to ensure adequacy of endotracheal cuff air volume.