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Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial

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Abstract

Purpose

Anterior cervical spine surgery is associated with postoperative dysphagia, sore throat and dysphonia. It is unclear, whether this is caused by increased endotracheal tube (ETT) cuff pressure after retractor placement. This study aims to assess the effect of ETT cuff pressure adjustment on postoperative dysphagia, sore throat and dysphonia.

Methods

In this, single-centre, observer and patient-blinded randomized controlled trial patients treated with anterior cervical spine surgery were randomized to adjustment of the ETT cuff pressure to 20 mmHg after placement of the retractor versus no adjustment. Primary outcome was the incidence and severity of postoperative dysphagia. Secondary outcomes were sore throat and dysphonia. Outcomes were evaluated on day one and 2 months after the operation.

Results

Of 177 enrolled patients, 162 patients (92.5%) could be evaluated. The incidence of dysphagia was 75.9% on day one and 34.6% 2 months after surgery. Dysphagia in the intervention and control group was present in 77.8% versus 74.1% of patients on day one (odds ratio (OR) 1.2, 95% confidence interval (CI) (0.6–2.5)) and 28.4% versus 40.7% of patients after 2 months (OR 0.6, 95% CI 0.3–1.1), respectively. Severity of dysphagia, sore throat and dysphonia was similar in both groups.

Conclusions

Anterior cervical spine surgery is accompanied by a high incidence of postoperative dysphagia, lasting until at least 2 months after surgery in over a third of our patients. Adjusting ETT cuff pressure to 20 mmHg after retractor placement, as compared to controls, did not lower the risk for both short- and long-term dysphagia.

Netherlands National Trial Registry Number: NTR 3542.

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Acknowledgements

We acknowledge Mrs. A. Hanschke and Mrs. Ch. Severijns for their role as research nurse in collecting the voice recordings, support in the data collection and obtaining the research grant. Furthermore, we acknowledge the department of speech and language therapy of the Hogeschool Rotterdam for their contribution in judging the GRADE score with regard to dysphonia

Funding

This study was funded by a small project grant from the internal scientific board of the Haaglanden Medical Centre to ensure the cooperation of research nurses and the purchase of the digital voice recorder.

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Authors and Affiliations

  1. Department of Anaesthesiology, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands

    Bastiaan A. in ’t Veld, Thijs C. D. Rettig, Naomi de Heij & Jessica de Vries

  2. Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands

    Jasper F. C. Wolfs & Mark P. Arts

Authors
  1. Bastiaan A. in ’t Veld
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  2. Thijs C. D. Rettig
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  3. Naomi de Heij
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  4. Jessica de Vries
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  5. Jasper F. C. Wolfs
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  6. Mark P. Arts
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Corresponding author

Correspondence to Bastiaan A. in ’t Veld.

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The authors declared that they have no conflict of interest.

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in ’t Veld, B.A., Rettig, T.C.D., de Heij, N. et al. Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial. Eur Spine J 28, 353–361 (2019). https://doi.org/10.1007/s00586-018-5798-3

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  • DOI: https://doi.org/10.1007/s00586-018-5798-3

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