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Original Research

Open Access

Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?

  • HAMED-BASIR GHAFOURI1
  • HOSSEIN SAEEIDI1
  • MOHAMMADREZA YASINZADEH1
  • SASAN FAMOURI 1
  • EHSAN MODIRIAN1

1Emergency Medicine Department Hazrat Rasoul Akram Hospital Niayesh St., Sattarkahn Ave. Tehran University of Medical Sciences

DOI: 10.22514/SV72.102012.3 Vol.7,Issue 2,October 2012 pp.17-20

Published: 29 October 2012

*Corresponding Author(s): EHSAN MODIRIAN E-mail: e-modirian@razi.tums.ac.ir

Abstract

Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer.

Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was 

blinded to the study purpose and an ideal pressure range of 20 to 30 cmH2O was used for analysis.

Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff 

pressure in our study was 69.2±29.8 cmH2O (range: 10-120 cmH2O) which was significantly different from the recommen-ded standard value of 25 cmH2O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6). Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube.

Keywords

endotracheal tube, cuff pressure, emergency physicians, anesthesiologist

Cite and Share

HAMED-BASIR GHAFOURI,HOSSEIN SAEEIDI,MOHAMMADREZA YASINZADEH,SASAN FAMOURI ,EHSAN MODIRIAN. Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?. Signa Vitae. 2012. 7(2);17-20.

References

1. Braz JR, Navarro LH, Takata IH, Nascimento Junior P. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J 1999;117:243-7.

2. Galinski M, Treoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med 2006;47:545-7.

3. Nseir S, Duguet A, Copin MC, De Jonckheere J, Zhang M, Similowski T, et al. Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care 2007;11(5):R109.

4. Stewart SL, Secrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J 2003;71:443-7.

5. Tu HN, Saidi N, Leiutaud T, Bensaid S, Menival V, Duvaldestin P. Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients. Anesth Analg 1999;89:187-90.

6. Honeybourne D, Costello JC, Barham C. Tracheal damage after endotracheal intubation: comparison of two types of endotracheal tubes. Thorax 1982 Jul;37(7):500-2.

7. Leigh JM, Maynard JP. Pressure on the tracheal mucosa from cuffed tubes. Br Med J 1979 May 5;1(6172):1173-4.

8. Hoffman RJ, Parwani V, Hsu B, Hahn I. Emergency physicians cannot inflate or estimate endotracheal tube cuff pressure using standard techniques. Ann Emerg Med 2004;44:S118-S19.

9. Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg 2010 Nov;111(5):1133-7 Epub 2010 Aug 24.

10. Svenson JE, Lindsay MB, O’Connor JE. Endotracheal intracuff pressures in the ED and prehospital setting: is there a problem? Am J Emerg Med 2007 Jan;25(1):53-6.

11. Sole ML, Penoyer DA, Su X, Jimenez E, Kalita SJ, Poalillo E, et al. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. Am J Crit Care 2009;18:133-43.

12. Seegobin RD, van Hasselt GL. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J (Clin Res Ed) 1984 Mar 31;288(6422):965-8.

13. Sengupta P, Sessler DI, Maglinger P, Wells S, Vogt A, Durrani J, et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol 2004;4:8.

14. Hoffman RJ, Parwani V, Hahn IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med 2006 Mar;24(2):139-43.

15. Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ven-tilation. J Bras Pneumol 2008 May;34(5):294-7.

16. Parwani V, Hahn IH, Krieger P, Zajac P, Arakaki D, Hoffman RJ. Assessing endotracheal tube cuff pressure. Emerg Med Serv 2006 Jan;35(1):82-4.

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