Critical Care and Shock

Endotracheal Cuff Pressures in Ventilated Patients in Intensive Care

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Aim: To describe the endotracheal cuff pressure (Pcuff) measurements of patients receiving ventilation via endotracheal tubes in an Intensive Care Unit (ICU).

Method: Pcuff were measured daily using a cuff tonometer and the pressure then adjusted to <30 cmH2O in patients ventilated in the ICU, over fifteen months. Data collected were demographics, the location where intubation occurred, and airway pressures when available (PEEP, peak, and plateau). Data was analysed using Kruskal-Wallis and Dunn’s Multiple Comparison Test.

Results: 1073 data sets were collected from 199 intubated ventilated adults. Of all Pcuff measured 15.7% (169) exceeded 30 cmH2O. The first Pcuff measurements made during ICU stay had median pressure 30 cmH2O (IQR 23.5-40) and 34.5% (68) exceeded 30 cmH2O. Median Pcuff of patients admitted following intubation in the Operating Theatre (OT) were 26 cmH2O (IQR 20-37), those via Emergency Department (ED) were 32 cmH2O (IQR 28-57), and those intubated in ICU were 28 cmH2O (IQR 22-34.25). Pcuff of patients intubated in OT differed significantly from ED patients, as did ICU patients compared to ED (p <0.005). ICU and OT patients did not differ.

Conclusion: Pcuff measurement is not routine at intubation. Described complications of elevated Pcuff include cuff herniation, vocal cord damage, tracheal mucosal ischaemia, and airway obstruction. Unrecognised elevated Pcuff is common, with a higher incidence in ED than ICU or OT. Skilled intubation assistance from anaesthetic technicians is routine in OT, common in ICU, but less frequent in ED, and may influence the initial Pcuff.

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