Evaluation of an Intervention to Maintain Endotracheal Tube Cuff Pressure Within Therapeutic Range

Abstract

Background Endotracheal tube cuff pressure must be kept within an optimal range that ensures ventilation and prevents aspiration while maintaining tracheal perfusion. Objectives To test the effect of an intervention (adding or removing air) on the proportion of time that cuff pressure was between 20 and 30 cm H2O and to evaluate changes in cuff pressure over time. Methods A repeated-measure crossover design was used to study 32 orally intubated patients receiving mechanical ventilation for two 12-hour shifts (randomized control and intervention conditions). Continuous cuff pressure monitoring was initiated, and the pressure was adjusted to a minimum of 22 cm H2O. Caregivers were blinded to cuff pressure data, and usual care was provided during the control condition. During the intervention condition, cuff pressure alarm or clinical triggers guided the intervention. Results Most patients were men (mean age, 61.6 years). During the control condition, 51.7% of cuff pressure values were out of range compared with 11.1% during the intervention condition (P < .001). During the intervention, a mean of 8 adjustments were required, mostly to add air to the endotracheal tube cuff (mean 0.28 [SD, 0.13] mL). During the control condition, cuff pressure decreased over time (P < .001). Conclusions The intervention was effective in maintaining cuff pressure within an optimal range, and cuff pressure decreased over time without intervention. The effect of the intervention on outcomes such as ventilator-associated pneumonia and tracheal damage requires further study.

Investigation of the Nurses Tracheostomy/Endotracheal Tube Cuff Pressure Practices in Intensive Care Units

“…Eğer sık izlem gerekliyse dört saatte bir bakılması gerektiği belirtilmektedir. 1,2,5,7,[16][17][18] Literatürde hemşirelerin %50-70'inin kaf basıncını 6-12 saatte bir ölçtükleri görülmektedir. 2,7 Çalışmamızdan elde edilen bulgulara göre ise literatürden farklı olarak hemşirelerin az bir kısmı uygun şekilde her vardiyada bir defa kaf basıncını ölçtüğünü ifade ederken, yarısından fazlası mekanik ventilatör alarm verdiğinde ölçtüğünü belirtmektedir.…”

“…7,15 Rose ve Redl çalışmalarında, katılımcıların büyük kısmının ETT/TT kaf basıncını yarı oturur pozisyonda ölçtüğü, bir kısmının ise ETT/TT kaf basıncı ölçümü için pozisyon vermeye gerek olmadığını belirttiklerini ifade etmişlerdir. Minimal tı-Turkiye Klinikleri J Nurs Sci 2016;8 (1) kanıklık tekniği kullanılarak kaf basıncının ölçül-düğü bir çalışmada hemşirelerin yarısının hastanın başını 30-45° kaldırarak semiekümbent pozisyonunu verdikleri ifade edilmektedir. Bir kısmının ise hiçbir pozisyon değişikliği yapmadığı belirtilmektedir.…”

How I Learned My ABCs: Action, Back to Basics, Collaboration, Discovery

“…Variation decreased after medication for pain or agitation. [26][27][28] From this study, we learned that continuous monitoring was feasible for research and that it provided rich data about the patient's physiological status. However, we realized that it would be impractical to use in everyday practice for cuff pressure management.…”

Recent Advances in Multidisciplinary Critical Care

“…Factors leading to increased cuff pressure include positivepressure ventilation, 17,18 ventilation with nitrous oxide, 19 altitude (eg, during helicopter transport), 20 and pathologic processes such as bronchospasms. 13 Factors that may decrease cuff pressure include sedation and neuromuscular blockade, 21 decreased core temperature, 22 and loss of intracuff volume over patients in the ICU. The goal was to identify symptom clusters associated with clinical depression in patients hospitalized with coronary heart disease.…”