Evaluation of Endotracheal Tube Cuff Pressure in Intubated Patients in Emergency Department, Operating Rooms, and Icus of Imam Khomeini Hospital Complex in 2018; A Cross Sectional Study
-
Amirhossein Orandi
,
Seyed Mohammad Mireskandari
,
Shahram Samadi
,
Negar Eftekhar
,
Mostafa Mohammadi
,
Mehdi Aminizadeh
Abstract
Background: Establishing and maintaining a secure airway using a cuffed endotracheal tube (ETT) is an important step in management of intubated patients. Out-of-range ETT cuff pressure is associated with various complications which could lengthen the hospital stay. The aim of this cross-sectional study was to evaluate ETT cuff pressure in intubated patients in the emergency department (ED), operating rooms (ORs), and Intensive Care Units (ICUs) of Imam Khomeini Hospital Complex (IKHC), Tehran, Iran.
Methods: The ETT cuff pressure of 153 patients was measured using a standard manometer. Demographic data and duration of intubation were recorded. The data were analysed using the SPSS software version 16. P values less than 0.05 were considered significant.
Results: The ETT cuff pressure exceeded the recommended range in 125 out of 153 patients (81.7%). The mean cuff pressure (67.29 cmH2O) was significantly higher than the recommended range (p<0.001). The cuff pressure was higher in patients in the ORs compared to patients in the ED and ICU (OR=8.46, p<0.001).
Conclusion: Intubation in the OR can be considered a risk factor for higher-than-normal ETT cuff pressure and subsequent complications. The ETT cuff pressure monitoring by means of a manometer is recommended.
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[2] Griffee M, Merkel M. Irwin and Rippe's Intensive Care Medicine, 6th Edition. Anesthesiology. 2008; 108:968-9.
[3] 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; 288(6422):965-8.
[4] Suzuki N, Kooguchi K, Mizobe T, Hirose M, Takano Y, Tanaka Y. [Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator]. Masui. 1999; 48(10):1091-5.
[5] Ansari L, Bohluli B, Mahaseni H, Valaei N, Sadr-Eshkevari P, Rashad A. The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: a randomized double-blind controlled clinical trial. Br J Oral Maxillofac Surg. 2014;52(2):140-3.
[6] Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Critical care medicine. 2005; 33(10):2184-93.
[7] Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care. 2011; 20(2):109-17; quiz 118.
[8] Maboudi A, Abtahi H, Hosseini M, Tamadon A, Safavi E. Accuracy of endotracheal tube cuff pressure adjustment by fingertip palpation after training of intensive care unit nurses. Iran Red Crescent Med J. 2013; 15(5):381-4.
[9] Bhatta K, Greer R. Awareness and monitoring of tracheal tube cuff pressure in a multidisciplinary intensive care unit. Anaesth Intensive Care. 2007; 35(2):302-3.
[10] Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, et al. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. J Clin Anesth. 2013; 25(1):28-31.
[11] Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation. J Bras Pneumol. 2008; 34(5):294-7.
[12] Sridermma S, Limtangturakool S, Wongsurakiat P, Thamlikitkul V. Development of appropriate procedures for inflation of endotracheal tube cuff in intubated patients. J Med Assoc Thai. 2007; 90 Suppl 2:74-8.
[13] Brandt L. Prevention of nitrous oxide-induced increases in endotracheal tube cuff pressure. Anesthesia and analgesia. 1991;72(2):262-3.
[14] Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001; 95(5):1120-4.
[15] 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; 25(1):53-6.
[16] Ozer A, Demirel I, Gunduz G, Erhan O. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure. Niger J Clin Pract. 2013; 16(2):253-7.
[17] mousavi saj, niakan lahiji m, akhovatian f, moradi moghadam o, valizade hassanlouei ma. An Investigation of endotracheal Tube cuff Pressure. Daneshvar Medicine. 2009;17(4):43-8.
[18] Jaber S, El Kamel M, Chanques G, Sebbane M, Cazottes S, Perrigault PF, et al. Endotracheal tube cuff pressure in intensive care unit: the need for pressure monitoring. Intensive Care Med. 2007;33(5):917-8.
[19] Nseir S, Brisson H, Marquette CH, Chaud P, Di Pompeo C, Diarra M, et al. Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur J Anaesthesiol. 2009;26(3):229-34.
[20] Emadi SA, Zamani A, Nasiri E, Khademlo M, Tatar M. Assessment of endotracheal tube cuff pressure after tracheal intubation during general anaesthesia. J Mazandaran Univ Med Sci. 2010; 20(76):9-13.
[21] Hoffman RJ, Parwani V, Hahn I-H. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006;24(2):139-43.
[22] Bassi M, Zuercher M, Erne J-J, Ummenhofer W. Endotracheal tube intracuff pressure during helicopter transport. Ann Emerg Med. 2010; 56(2):89-93. e1.
[23] Chapman J, Pallin D, Ferrara L, Mortell S, Pliakas J, Shear M, et al. Endotracheal tube cuff pressures in patients intubated before transport. Am J Emerg Med. 2009; 27(8):980-2.
[24] 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(6):545-7.
[25] Schneider J, Mulale U, Yamout S, Pollard S, Silver P. Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children. J Crit Care. 2016; 36:173-7.
[26] Danielis M, Benatti S, Celotti P, De Monte A, Trombini O. [Continuous monitoring of endotracheal tube cuff pressure: best practice in intensive care unit]. Assist Inferm Ric. 2015; 34(1):15-20.
[27] Orandi A, Orandi A, Najafi A, Hajimohammadi F, Soleimani S, Zahabi S. Post-intubation sore throat and menstruation cycles. Anesth Pain Med. 2013;3(2):243-9.
[28] Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Anesthesia E-Book: Elsevier Health Sciences; 2009.
[29] Ulrich-Pur H, Hrska F, Krafft P, Friehs H, Wulkersdorfer B, Kostler WJ, et al. Comparison of mucosal pressures induced by cuffs of different airway devices. Anesthesiology. 2006;104(5):933-8.
[30] Vyas D, Inweregbu K, Pittard A. Measurement of tracheal tube cuff pressure in critical care. Anaesthesia. 2002; 57(3):275-7.
[31] Duguet A, D'Amico L, Biondi G, Prodanovic H, Gonzalez-Bermejo J, Similowski T. Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med. 2007;33(1):128-32.
[32] Stewart SL, Seacrest J, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003; 71(6):443-8.
[33] Trivedi L, Jha P, Bajiya NR, Tripathi D. We should care more about intracuff pressure: The actual situation in government sector teaching hospital. Indian J Anaesth. 2010; 54(4):314.
[34] White DM, Redondo JI, Mair AR, Martinez-Taboada F. The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. Vet Anaesth Analg. 2017; 44(5):1076-84.
[35] Bernhard WN, Yost L, Joynes D, Cothalis S, Turndorf H. Intracuff pressures in endotracheal and tracheostomy tubes: related cuff physical characteristics. Chest. 1985;87(6):720-5.
[36] 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;111(5):1133-7.
[37] Rello J, Sonora R, Jubert P, Artigas A, Rué M, Vallés J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med. 1996;154(1):111-5.
[38] Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
[2] Griffee M, Merkel M. Irwin and Rippe's Intensive Care Medicine, 6th Edition. Anesthesiology. 2008; 108:968-9.
[3] 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; 288(6422):965-8.
[4] Suzuki N, Kooguchi K, Mizobe T, Hirose M, Takano Y, Tanaka Y. [Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator]. Masui. 1999; 48(10):1091-5.
[5] Ansari L, Bohluli B, Mahaseni H, Valaei N, Sadr-Eshkevari P, Rashad A. The effect of endotracheal tube cuff pressure control on postextubation throat pain in orthognathic surgeries: a randomized double-blind controlled clinical trial. Br J Oral Maxillofac Surg. 2014;52(2):140-3.
[6] Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Critical care medicine. 2005; 33(10):2184-93.
[7] Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care. 2011; 20(2):109-17; quiz 118.
[8] Maboudi A, Abtahi H, Hosseini M, Tamadon A, Safavi E. Accuracy of endotracheal tube cuff pressure adjustment by fingertip palpation after training of intensive care unit nurses. Iran Red Crescent Med J. 2013; 15(5):381-4.
[9] Bhatta K, Greer R. Awareness and monitoring of tracheal tube cuff pressure in a multidisciplinary intensive care unit. Anaesth Intensive Care. 2007; 35(2):302-3.
[10] Minonishi T, Kinoshita H, Hirayama M, Kawahito S, Azma T, Hatakeyama N, et al. The supine-to-prone position change induces modification of endotracheal tube cuff pressure accompanied by tube displacement. J Clin Anesth. 2013; 25(1):28-31.
[11] Godoy AC, Vieira RJ, Capitani EM. Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation. J Bras Pneumol. 2008; 34(5):294-7.
[12] Sridermma S, Limtangturakool S, Wongsurakiat P, Thamlikitkul V. Development of appropriate procedures for inflation of endotracheal tube cuff in intubated patients. J Med Assoc Thai. 2007; 90 Suppl 2:74-8.
[13] Brandt L. Prevention of nitrous oxide-induced increases in endotracheal tube cuff pressure. Anesthesia and analgesia. 1991;72(2):262-3.
[14] Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology. 2001; 95(5):1120-4.
[15] 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; 25(1):53-6.
[16] Ozer A, Demirel I, Gunduz G, Erhan O. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure. Niger J Clin Pract. 2013; 16(2):253-7.
[17] mousavi saj, niakan lahiji m, akhovatian f, moradi moghadam o, valizade hassanlouei ma. An Investigation of endotracheal Tube cuff Pressure. Daneshvar Medicine. 2009;17(4):43-8.
[18] Jaber S, El Kamel M, Chanques G, Sebbane M, Cazottes S, Perrigault PF, et al. Endotracheal tube cuff pressure in intensive care unit: the need for pressure monitoring. Intensive Care Med. 2007;33(5):917-8.
[19] Nseir S, Brisson H, Marquette CH, Chaud P, Di Pompeo C, Diarra M, et al. Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur J Anaesthesiol. 2009;26(3):229-34.
[20] Emadi SA, Zamani A, Nasiri E, Khademlo M, Tatar M. Assessment of endotracheal tube cuff pressure after tracheal intubation during general anaesthesia. J Mazandaran Univ Med Sci. 2010; 20(76):9-13.
[21] Hoffman RJ, Parwani V, Hahn I-H. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006;24(2):139-43.
[22] Bassi M, Zuercher M, Erne J-J, Ummenhofer W. Endotracheal tube intracuff pressure during helicopter transport. Ann Emerg Med. 2010; 56(2):89-93. e1.
[23] Chapman J, Pallin D, Ferrara L, Mortell S, Pliakas J, Shear M, et al. Endotracheal tube cuff pressures in patients intubated before transport. Am J Emerg Med. 2009; 27(8):980-2.
[24] 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(6):545-7.
[25] Schneider J, Mulale U, Yamout S, Pollard S, Silver P. Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children. J Crit Care. 2016; 36:173-7.
[26] Danielis M, Benatti S, Celotti P, De Monte A, Trombini O. [Continuous monitoring of endotracheal tube cuff pressure: best practice in intensive care unit]. Assist Inferm Ric. 2015; 34(1):15-20.
[27] Orandi A, Orandi A, Najafi A, Hajimohammadi F, Soleimani S, Zahabi S. Post-intubation sore throat and menstruation cycles. Anesth Pain Med. 2013;3(2):243-9.
[28] Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Anesthesia E-Book: Elsevier Health Sciences; 2009.
[29] Ulrich-Pur H, Hrska F, Krafft P, Friehs H, Wulkersdorfer B, Kostler WJ, et al. Comparison of mucosal pressures induced by cuffs of different airway devices. Anesthesiology. 2006;104(5):933-8.
[30] Vyas D, Inweregbu K, Pittard A. Measurement of tracheal tube cuff pressure in critical care. Anaesthesia. 2002; 57(3):275-7.
[31] Duguet A, D'Amico L, Biondi G, Prodanovic H, Gonzalez-Bermejo J, Similowski T. Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med. 2007;33(1):128-32.
[32] Stewart SL, Seacrest J, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003; 71(6):443-8.
[33] Trivedi L, Jha P, Bajiya NR, Tripathi D. We should care more about intracuff pressure: The actual situation in government sector teaching hospital. Indian J Anaesth. 2010; 54(4):314.
[34] White DM, Redondo JI, Mair AR, Martinez-Taboada F. The effect of user experience and inflation technique on endotracheal tube cuff pressure using a feline airway simulator. Vet Anaesth Analg. 2017; 44(5):1076-84.
[35] Bernhard WN, Yost L, Joynes D, Cothalis S, Turndorf H. Intracuff pressures in endotracheal and tracheostomy tubes: related cuff physical characteristics. Chest. 1985;87(6):720-5.
[36] 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;111(5):1133-7.
[37] Rello J, Sonora R, Jubert P, Artigas A, Rué M, Vallés J. Pneumonia in intubated patients: role of respiratory airway care. Am J Respir Crit Care Med. 1996;154(1):111-5.
[38] Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
| Files | ||
| Issue | Vol 7 No 2 (2021): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v7i2.6299 | |
| Keywords | ||
| Intubation Endotracheal Tube Cuff pressure Anesthesia | ||
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How to Cite
1.
Orandi A, Mireskandari SM, Samadi S, Eftekhar N, Mohammadi M, Aminizadeh M. Evaluation of Endotracheal Tube Cuff Pressure in Intubated Patients in Emergency Department, Operating Rooms, and Icus of Imam Khomeini Hospital Complex in 2018; A Cross Sectional Study. Arch Anesth & Crit Care. 2021;7(2):69-74.
