We should care more about intracuff pressure: The actual situation in government sector teaching hospital

Abstract

Endotracheal tube (ETT) should have intracuff pressure (ICP) in the range of 20 to 30 cm water (H2O). In this observational study, we studied the trend amongst anaesthesiologist in choosing the type of ETT and their ability to assess optimum ICP clinically. After institutional ethics committee approval, we observed 75 patients under general endotracheal anaesthesia in Government Medical College. Anaesthesiologists were blinded to study purpose. The type of ETT used and magnitude of ICP was recorded. ICP was measured using simple aneroid manometer. Once the pressure was measured, it was readjusted to normal range and nitrous oxide was allowed to start. Red rubber tube was used in 18.7% and polyvinyl chloride (PVC) in 81.3% cases. The anaesthesiologists were not able to assess ICP in the recommended range clinically in 100% cases when red rubber ETT was used and in 40% cases when portex ETT was used. Red rubber ETT (reusable) with low-volume high-pressure cuff is still in use, though the trend is shifting towards more of using PVC ETT. Anaesthesiologists were not able to inflate the ETT cuff to the recommended range in spite of their clinical expertise (more than 5 years of teaching experience) in significant number of cases. We recommend the use of simple aneroid manometer for objective monitoring of ICP over subjective assessment, not only in red rubber, but also in PVC ETT.

Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg academic hospitals

“…A study conducted in Denmark showed a median ETT cuff pressure of 30 cm H₂O (range 8-100) compared with the median pressure of 36 cm H₂O (range 10-120) recorded in our study. 8 In our study 62 (64.58%) patients had ETT cuff pressures > 30 cm H₂O, compared with 50% in the American study, 5 45% of patients in the Danish study, 8 26.2% in the Indian study 6 and 23% in the Cape Town study. 7 Only 18 (18.75%) patients in our study had an ETT cuff pressure within the normal range whereas in the American study 27% of patients had normal ETT cuff pressures and in the Indian study 59% of ETT cuff pressures were normal.…”

“…Mean ETT cuff pressure of 27.07 cm H₂O was recorded in a study conducted in a government teaching hospital in India. 6 Bernon et al 7 in 2013, in an academic hospital in Cape Town, reported a mean cuff pressure of 25 cm H₂O in anaesthetised patients. A study conducted in Denmark showed a median ETT cuff pressure of 30 cm H₂O (range 8-100) compared with the median pressure of 36 cm H₂O (range 10-120) recorded in our study.…”

“…This was based on an expected frequency of 45% of ETT cuff pressures being greater than 30 cm H₂O. The expected frequency was obtained by using data based on previous international 5,6,8 studies that measured ETT cuff pressures during anaesthesia. A 10% precision and 95% confidence level was used to calculate the sample size.…”

“…Both international 5,6,8 and local 7 literature has shown that ETT cuff pressure during anaesthesia commonly exceeds the maximum recommended pressure of 30 cm H₂O.…”

Acute Airway Obstruction Due To Dissection Of The Endotracheal Tube

“…(5) Trivedi ve ark. (6) yaptıkları çalışmada; PVC tüplerle, kırmızı plastik (düşük volüm-yüksek basınç kaflı) çok kullanımlık tüp-leri karşılaştırdıklarında, PVC tüpler kullanıldığında da kaf içi basıncın manometre ile ölçülmesinin daha güvenli olduğu gös-terilmiştir.…”