Peri-cuff air leakage and computed tomography-derived tracheal dimensions in patients with Amyotrophic Lateral Sclerosis receiving long-term tracheostomy invasive ventilation: A cross-sectional study

Nobuhiko Shibasaki, Tetsuo Miyagawa, Kaoru Konishi

Abstract

Background

In patients with amyotrophic lateral sclerosis (ALS) receiving long-term tracheostomy invasive ventilation (TIV), peri-cuff air leakage may be related not only to insufficient cuff pressure but also to tracheal enlargement and cuff–trachea diameter mismatch. However, to our knowledge, no previous studies have compared computed tomography (CT)-derived tracheal dimensions, tracheostomy tube and cuff characteristics, and ventilator monitoring data between patients with and without peri-cuff air leakage under long-term TIV management in ALS.

Methods

This was a single-center, retrospective, cross-sectional observational study. Patients with ALS who were receiving TIV at the study hospital in October 2020 and had undergone chest CT within the 3 months before patient selection were included. Patients were classified into the leak and non-leak groups according to the presence or absence of peri-cuff air leakage based on medical record entries during the period from 1 month before to 1 month after the index CT examination. Patient characteristics, tracheostomy tube and cuff characteristics, CT-derived tracheal dimensions, and ventilator monitoring data were compared between the groups.

Results

Twenty-six patients were included in the analysis: 10 in the leak group and 16 in the non-leak group. Patient characteristics did not differ significantly between the groups. Compared with the non-leak group, the leak group had higher cuff pressure, larger major and minor tracheal diameters, higher peak inspiratory pressure, a larger difference between major and minor tracheal diameters, lower dynamic compliance, and a smaller difference between cuff diameter and major tracheal diameter. The difference between cuff diameter and major tracheal diameter was −2.3 (−4.1 to −1.6) mm in the leak group and 1.8 (0.7 to 3.0) mm in the non-leak group (P < 0.001). The Hodges–Lehmann estimate of the between-group difference was −4.7 mm (95% CI, −7.4 to −3.2 mm). All patients in whom the cuff diameter was smaller than the major tracheal diameter were classified into the leak group.

Conclusions

In patients with ALS receiving long-term TIV, peri-cuff air leakage was associated with larger CT-derived tracheal dimensions and a smaller cuff diameter relative to the major tracheal diameter. These findings suggest that cuff–trachea diameter compatibility, in addition to cuff pressure, may be relevant when evaluating peri-cuff air leakage. However, the small sample size limited statistical precision and precluded multivariable adjustment; therefore, the findings should be interpreted as exploratory.

Keywords: Amyotrophic Lateral Sclerosis; Tracheostomy; Respiration, Artificial; Airway Management; Peri-cuff Air Leakage

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