Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres

Abstract

Correct intracuff pressure of endotracheal tubes and supraglottic airway devices is required to avoid complications such as sore throat, dysphagia and dysphonia, while maintaining an adequate airway seal. However, intracuff pressure monitoring of airway devices during general anaesthesia may not receive the attention it deserves. The aim of this survey was to investigate the current practice regarding intraoperative cuff pressure monitoring in hospitals across Australia and New Zealand. An online ten-question survey was disseminated by the Australian and New Zealand College of Anaesthetists Clinical Trials Network to a randomised selection of 1000 Australian and New Zealand College of Anaesthetists Fellows working in private and public hospitals of varying sizes. There were 305 respondents in total, but not all respondents answered all questions. In total, 67 of 304 respondents (22.0%) did not have access to a cuff pressure manometer at their main site of work, and of these, 30 (9.9%) expressed that they would like access to one in their daily practice. Of 288 respondents, 122 (40.0%) reported that they used cuff pressure monitoring as part of their routine practice, but 95 (33.0%) measured the cuff pressure at induction only. For supraglottic airway devices, only 44 of 250 respondents (17.6%) aimed for a cuff pressure of 40–60 cmH2O. Of 255 respondents, 101 (39.6%) aimed for a cuff pressure of 20–30 cmH2O for endotracheal tubes. These findings indicate that educational programmes are required to increase the availability and use of cuff pressure monitoring devices for both endotracheal tubes and supraglottic airway devices across Australia and New Zealand.

Do we need inbuilt pressure monitoring systems across all cuffed airway devices?

“…Yet 63% (61/96) had been overinflated. 2 We have since conducted a departmental survey between March and April 2018 and would like to report our results, which also support the findings of Lee et al 1 A questionnaire survey was distributed to all the consultant anaesthetists (n ¼ 35) and the anaesthetic nursing staff (n ¼ 24) of our department. The survey was approved by the Human Research Ethics Committee of the Central Adelaide Local Health Network (reference no: Q20171003).…”

“…Venkatesan Thiruvenkatarajan 1,2 , John Currie 1 , Richard B Emmerson 3 and Roelof M Van Wijk 1,2 We read with interest the bi-national survey by Lee et al on the practice of cuff pressure monitoring of endotracheal tubes and supraglottic airway devices (SADs), highlighting the need for ongoing education related to this practice. 1 We recently published a prospective observational study (n ¼ 150) assessing the predictors of early postoperative pharyngolaryngeal complications arising from cuffed SADs, which found an overinflation rate of 62%. 2 During this previous study, manometers were available in every operating room and two-thirds of our assessed cuffed SADs (96/150) were of the inbuilt pressure indicator type.…”

Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country

“…It is obvious that in spite of the better level of knowledge and practice among the participants in the Brazilian study tracheal cuff pressure management could be said to be currently poor globally. A bi-national survey was conducted in 2019 to evaluate the prevailing practice regarding intraoperative cuff pressure monitoring in private and public hospitals across Australia and New Zealand [ 21 ]. Among the 1000 randomly selected anaesthesia faculty fellows, 78.0% submitted that they had ready access to cuff pressure manometer in their hospital, but only 40.0% used them routinely in their practice.…”

Accuracy of pilot balloon palpation for cuff pressure assessment in small versus large sized tubes: a prospective non-randomized observational study

“…Accordingly, it is recommended that the cuff pressure is properly inflated and assessed to be within the ranges of 20-30 cmH 2 O 1 , 4 . Among the various methods of evaluating appropriate cuff pressure, the most commonly used technique is recognizing the tactile sensation by directly touching the pilot balloon between fingers, and it has been reported to be used in about 44–51% 6 , 7 . The tactile perception method was reported to be more inaccurate than using a pressure gauge 8 , but hospitals still do not use a pressure gauge in every operating room due to either cost reasons or inconvenience or both 9 .…”