Unintentional endotracheal tube cuff deflation during routine checks: a simulation study

Abstract

Background Endotracheal tube cuff pressures should be maintained between 20 and 30 cm H2O to prevent the aspiration of subglottic secretions past the cuff. Guidance recommends regular monitoring of the cuff pressure, performed using a handheld manometer/inflator. Poor technique can lead to transient deflation of the cuff, leading to the bolus aspiration of upper respiratory tract secretions, tracheal colonization and, ultimately, ventilator‐associated pneumonia. Aims and objectives To determine whether intensive care staff transiently deflate the endotracheal tube cuff to below 20 cm H2O during routine cuff pressure checks when using a handheld manometer/inflator device. Design This was an exploratory simulation study. Methods A sample of medical (n = 10) and nursing staff (n = 10), capable of caring for a tracheally intubated patient, participated in the study on a single day. A mannequin was intubated with a standard oral endotracheal tube with the cuff pressure set at 50 cm H2O. Participants were required to check and correct the cuff pressure to the appropriate level with a manometer. The lowest attained and the final target pressures were recorded. Results Three doctors were unfamiliar with the manometer and did not attempt measurement. During cuff pressure readjustment, 59% (10/17) of participants transiently deflated the cuff below 20 cm H2O and then re‐inflated to attain the final pressure. Of these participants, four deflated the cuff pressure to 0 cm H2O before re‐adjusting it back into range. Most participants, 88% (15/17), corrected the final cuff pressure to between 20 and 30 cm H2O. Conclusions Poor technique when using the manometer led to unintentional cuff deflation during routine checks. In clinical practice, this could increase the risk of pulmonary aspiration and ventilator‐associated pneumonia. Further research into alternatives for handheld manometers, such as automated continuous cuff pressure monitors, is warranted. Relevance to clinical practice Cuff deflations can easily occur during routine cuff pressure checks. Staff should be aware of the implications of cuff deflations and seek to improve training with manometers.

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

“…Furthermore, there was an expression of concern for the cause of leaks by one respondent, which has been demonstrated in the literature. 27,28 For example, cuff pressure drops can be experienced from the initial connection or disconnection of the manometer to the pilot balloon and less frequently by the pressure gauge of the manometer. 27 However, correct use of cuff manometers with three-way valves or the use of continuous monitoring techniques have been described to avoid this complication.…”

A mobile terminal application program was used for endotracheal tube cuff pressure measurement

“…Compared with intermittent measurement, a continuous ETT cuff pressure control system could better maintain the cuff pressure within the recommended range [18,19]. However, we lack a continuous ETT cuff pressure control system, so we used the manometer to measure cuff pressure every 8 h and maintained the pressure at 30 cm H 2 O (the upper limit of the recommended range) for each cuff pressure measurement.…”

The Relationship between Cuff Pressure and Air Injection Volume of Endotracheal Tube: A Study with Sheep Trachea Ex Vivo

“…(2) Due to the lack of pressure measuring devices, doctors and nurses often estimate the pressure of the endotracheal tube cuff by palpation [ 16 , 17 ]. (3) It has been pointed out that some anesthesiologists are not comfortable in using pressure measuring devices because using them can lead to air leakage of the cuff [ 18 , 19 ]. Harm et al pointed out that the average cuff pressure in a single hospital was 63.17 ± 32.79 cm H 2 O [ 20 ].…”