Accuracy of pilot balloon palpation in small sized tubes compared to large sized tubes: A prospective observational study

Abstract

Purpose After inflating the cuff of the endotracheal tube, the pressure of the cuff should be evaluated as to whether it is appropriate for ventilation. The most commonly used method is pilot balloon palpation. This study evaluated whether the size of the tracheal tube influenced the accuracy of pilot balloon palpation. Methods A prospective observational analysis of 208 patients intubated with an endotracheal tube of internal diameter (ID) 6.0 or 8.0 was conducted. An anesthesiologist first judged whether the cuff pressure was appropriate by manual pilot balloon palpation, and then measured the cuff pressure with a pressure gauge. If the cuff pressure exceeded 20–30 cmH2O, it was defined as a false recognition. Results The intracuff pressure was significantly higher in ID 6.0 tube than in the ID 8.0 tube (41.9 ± 18.8 cmH2O vs. 30.3 ± 11.9 cmH2O, p < 0.001). The number of patients that were mistakenly perceived to have appropriate cuff pressure by pilot balloon palpation was significantly higher in the ID 6.0 group compared to the ID 8.0 group (85 (81.7%) vs. 64 (61.5%), p = 0.001). Conclusions The incidence of inaccurate assessment of adequate cuff pressure when determining cuff pressure by pilot balloon palpation was higher in the relatively smaller endotracheal tube size group compared to the larger endotracheal tube size group. Therefore, use of a pressure gauge to confirm adequate pressure is recommended especially when using a smaller tube size.