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

Abstract

Background Tracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria. Methods This was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 tertiary hospitals in Nigeria, selected by stratified random sampling. Results Only 3.1% (6/196) of the care providers admitted having ever used a tracheal cuff manometer, while 31.1% knew the recommended tracheal cuff pressure. The nationwide telephone survey of anaesthesia faculty fellows revealed that tracheal cuff manometer is neither available, nor has it ever been used in any of the 13 tertiary hospitals surveyed. The ‘Pilot balloon palpation method’ and ‘fixed volume of air from a syringe’ were the most commonly utilized method of cuff pressure estimation by the care providers, at 64.3% and 28.1% respectively in part A survey (84.6% and 15.4% respectively, in the part B survey). Conclusion The use of tracheal cuff manometer is very limited among the care providers surveyed in this study. Knowledge regarding tracheal cuff management among the providers is adjudged to be fair, despite the poor practice and unsafe care.

A study to understand the current practices regarding the use of cuffed endotracheal tubes in pediatric anaesthesia amongst Indian anaesthesiologists

“…The gold standard for cuff pressure monitoring has been the intermittent manual manometer, and guidelines have since recommended that cuff pressure should be maintained at 20-30 cm H2O [6] . There is preponderance of evidence that tracheal tube cuffs are improperly inflated when manometers are not used 5 . When questioned whether or not intracuff pressure monitoring was done while using cuffed endotracheal tube, only 28.8% responded yes while 56.4% responded no.…”

“…The question was not applicable to 14.7% who use only uncuffed endotracheal tubes. Arinze Duke George Nwosu, Edmund Ndudi Ossai 5 et al conducted a study titled 'Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country'. This was a multicenter crosssectional study conducted from March 18 to April 30, 2021.…”

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: study protocol for a randomized controlled trial

“…At present, two methods are commonly used to monitor cuff pressure in clinical practice. Many anesthesiologists prefer the pilot balloon palpation method to estimate the cuff pressure despite the risk of endotracheal cuff overinflation [ 9 ]. Most respiratory physicians’ choice to measure cuff pressure is an endotracheal cuff pressure manometer.…”

Endotracheal Tube Cuff Pressures in the Operating Room of a Pediatric Hospital: A Quality Improvement Initiative

“…11,22 This device is rarely used in the operating room environment and has problems such as unintentional leaks, increased expense, and the need to clean the equipment between patients. 22–26 Despite manometry being the standard, most practitioners do not use them. Instead, many anesthesia providers inflate the ETT cuff using “estimation techniques.” These methods are used 98% of the time in the clinical setting but are subjective and not consistently accurate.…”

“…These methods are used 98% of the time in the clinical setting but are subjective and not consistently accurate. 7,13,14,[24][25][26] Also, the inflation method used is at the provider's discretion resulting in a wide variety of methods used in the clinical setting. With objective measurements not being used, estimation techniques being unreliable, and the wide range of methods practitioners use in the clinical setting, cuff pressures continue to be inaccurate.…”