[Toby's mum]

My instructor asked us to find out the answers to the following (I've looked in several books but can't find the answers)--I'm hoping allnurses can help.

1) What is the maximum volume (mL) that you can inflate the pilot balloon on an ET?


2) How many days can you keep an adult ICU patient on a vent sedated with Diprivan (allowing daily lightening).

Many thanks in advance for your help.

[RNnTraining1973]

I know our policy for propofol is 72 hours, then the MD must reevaluate for another method of sedation. I am not sure if each hospital has it's own policy or not on the length of time.

Melanie = )

[Dirk]

To question 2)
Propofol is used on my ICU to some patients for a really lomg time, without any problems.
But there are reports about people, have experienced severe problems because of propofol. One very critical thing, you have to look at is rhabdomyolysis, which can occur, because of a reduced energy production while there is a increased energy need in the heart- and skeleton muscles.

The pharmacological commision of the german physicians provides the use of Propofol for not longer than 7 days.

Greetings

Dirk

(http://www.akdae.de/20/20/Archiv/2004/200412101.pdf)

[charles-thor]

Most ett cuffs utilized today employ low pressure and high volume balloons.

The appropriate question should have been, “what is the maximum PRESSURE that is acceptable in an ett balloon – as pressure will change according to both the volume of the tracheal lumen and compliance of tracheal tissues. Put another way, the same volume will result in different pressures according to the two variables mentioned above. Furthermore, these variables are not static (i.e. lumenal diameter may be reduced over time secondary to edema from prolonged intubation).

Tracheal capillary hydrostatic pressure is approximately 25-35 mmHg, so exceeding this pressure will severely diminish or even eliminate flow distal to the occlusion.

Bottom line – the pressure in the ett balloon should not exceed ~25 mmHg (play it safe) or else perfusion to the surrounding tissues will be in jeopardy.

What is better than contemplating Boyal's law when inflating an ett balloon?

I hope this helps.