Introduction: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmHO impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmHO as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS.
Methods: We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool.
Results: We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmHO. The mean lies 40 cmHO above the maximum accepted value of 30 cmHO (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmHO, the maximum pressure on the analog gauge.
Conclusion: Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102598 | PMC |
| http://dx.doi.org/10.5811/westjem.2016.8.30639 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Comparison of core temperature using tracheal thermometer and pulmonary artery catheter in adult patients undergoing coronary artery bypass graft surgery.
PLoS One
January 2025
Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Background: Monitoring core temperature is important for patients under anesthesia. Esophageal and pulmonary artery blood temperatures can be used for measuring core temperature during general anesthesia. However, these methods pose challenges, especially when the placement of an esophageal thermometer and pulmonary artery catheter (PAC) is either impractical or not the preferred approach.
View Article and Find Full Text PDFA simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.
Anaesth Intensive Care
December 2024
Department of Anaesthesia, Royal Hobart Hospital, Hobart, Australia.
A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation.
View Article and Find Full Text PDFReevaluating 30 cmHO endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation.
Front Med (Lausanne)
November 2024
Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, China.
Background: The optimal endotracheal tube (ETT) cuff pressure remains contentious. In the traditional consideration that the level 30 cmHO is considered safe, balancing the prevention of reflux aspiration against airway mucosal damage. Whether this pressure level can cause potential damage to the airway mucosa remains to be discussed.
View Article and Find Full Text PDFDesign considerations for development of cuffed endotracheal tube for small airways.
Paediatr Anaesth
February 2025
Research and Development, Acute Care & Monitoring, Medtronic, Athlone, Ireland.
Article Synopsis
- * Neonates and pediatric patients have specific airway structures and functional needs that influence the design of ETTs, making it important to cater to these requirements.
- * While historically uncuffed ETTs were preferred for children under eight, advancements in cuffed ETT design now allow for safer use in smaller, more delicate airways.
Management of adult mechanically ventilated patients: A UK-wide survey.
J Intensive Care Soc
October 2024
General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Background: Mechanical ventilation is a common and often lifesaving intervention that is utilised in intensive care. However, the practices can vary between centres. Through this national survey we aim to gain more information about different strategies adopted across the UK.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!