Incidence of gastric insufflation at high compared with low laryngeal mask cuff pressure

BACKGROUND The success of ventilation with a laryngeal mask depends crucially on the seal between the mask and the periglottic tissue. Increasing the laryngeal mask's cuff volume is known to reduce oral air leakage but may lead to gastric insufflation. OBJECTIVE We hypothesised that a lower cuff pressure would result in less gastric insufflation. We sought to compare gastric insufflation with laryngeal mask cuff pressures of 20 cmH 2 O (CP 20 ) and 60 cmH 2 O (CP 60 ) during increasing peak airway pressures in a randomised controlled double-blind cross-over study. We also evaluated the incidence of gastric insufflation at the recommended peak airway pressure of 20 cmH 2 O or less and during both intermittent positive airway pressure and continuous positive airway pressure. METHODS After obtaining ethics approval and written informed consent, 184 patients ventilated via laryngeal mask received a stepwise increase in peak airway pressure from 15 to 30 cmH 2 O with CP 20 and CP 60 in turn. Gastric insufflation was determined via real-time ultrasound and measurement of the cross-sectional area of the gastric antrum. The primary endpoint was the incidence of gastric insufflation at the different laryngeal mask cuff pressures. RESULTS Data from 164 patients were analysed. Gastric insufflation occurred less frequently at CP 20 compared with CP 60 ( P < 0.0001). Gastric insufflation was detected in 35% of cases with CP 20 and in 48% with CP 60 at a peak airway pressure of 20 cmH 2 O or less. Gastric insufflation occurred more often during continuous than during intermittent positive airway pressures ( P < 0.01). CONCLUSION A laryngeal mask cuff pressure of 20 cmH 2 O may reduce the risk of gastric insufflation during mechanical ventilation. Surprisingly, peak airway pressure of 20 cmH 2 O or less may already induce significant gastric insufflation. Continuous positive airway pressure should be avoided due to an increased risk of gastric insufflation. CLINICAL TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (DRKS00010583) https://www.drks.de.