Assessment of Endotracheal Cuff Pressure by Continuous Monitoring: A Pilot Study

Abstract

Background Endotracheal tube cuff pressure must be maintained within a narrow therapeutic range to prevent complications. Cuff pressure is measured and adjusted intermittently. Objectives To assess the accuracy and feasibility of continuous monitoring of cuff pressure, describe changes in cuff pressure over time, and identify clinical factors that influence cuff pressure. Methods In a pilot study, data were collected for a mean of 9.3 hours on 10 patients who were orally intubated and receiving mechanical ventilation. Sixty percent of the patients were white, mean age was 55 years, and mean intubation time was 2.8 days. The initial cuff pressure was adjusted to a minimum of 20 cm H 2 O. The pilot balloon of the endotracheal tube was connected to a transducer and a pressure monitor. Cuff pressure was recorded every 0.008 seconds during a typical 12-hour shift and was reduced to 1-minute means. Patient care activities and interventions were recorded on a personal digital assistant. Results Values obtained with the cufflator-manometer and the transducer were congruent. Only 54% of cuff pressure measurements were within the recommended range of 20 to 30 cm H 2 O. The cuff pressure was high in 16% of measurements and low in 30%. No statistically significant changes over time were noted. Endotracheal suctioning, coughing, and positioning affected cuff pressure. Conclusions Continuous monitoring of cuff pressure is feasible, accurate, and safe. Cuff pressures vary widely among patients.

Evaluation of an Automated Endotracheal Tube Cuff Controller During Simulated Mechanical Ventilation

“…11 Striking the necessary balance between underinflation and overinflation requires rigorous cuff management. 12 In response to this need, various devices have been manufactured to automatically and continuously control cuff pressures, and several were shown to more successfully maintain ETT cuff pressure compared to the standard practice of manually measuring and adjusting cuff pressure with a manometer and syringe. [13][14][15][16][17] Nonetheless, these devices have not seen widespread implementation in the clinical setting.…”

Tracheal cuff pressure change before and after the performance of nursing care

“…Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial (12) . Previous studies have shown that maintaining ETT cuff pressure between 15 and 25 mm Hg can reduce endotracheal intubation-related complications in patients undergoing general anesthesia (13)(14) .…”

“…The pressure exerted on the trachea must be maintained within a therapeutic range (25 -30 cmH 2 O or 18 -22 mmHg) that is high enough to ensure delivery of mechanical ventilation and prevention of marked aspiration, but low enough to ensure perfusion to the tracheal capillaries without causing injury (2,8) .…”

Recent Advances in Multidisciplinary Critical Care

“…These data illustrate the need for strict guidelines on cuff pressure monitoring practice. 14,[24][25][26] Oral care is a clinical challenge in intubated patients. Many nurses find oral hygiene difficult and sometimes even frustrating as they have the impression that oral health worsens despite all the efforts taken.…”