Endotracheal Tube Cuff Pressure in Patients Admitted to Intensive Care Units After Cardiac Surgery

Document Type : Original Article

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, IR Iran.

3 School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, IR Iran.

4 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Khomein University of Medical Sciences, Khomein, IR Iran.

Abstract

Background: The endotracheal tube (ETT) cuff pressure must be kept within the range of 20 to 30 cmH2O in order to prevent tube displacement and air leakage, maintain the circulation of the tracheal capillaries, and prevent the aspiration of oral and gastric contents to the lower parts of the respiratory tract. This study aimed to determine the ETT cuff pressure and appropriate intervals for measuring it in patients admitted to intensive care units (ICUs).
 
Methods: This descriptive cross-sectional study was conducted on 100 patients after cardiac surgery with general anesthesia admitted to ICUs between May and November 2017. For each research unit, the ETT cuff pressure was measured twice at a 6-hour interval using a cuff pressure manometer. Descriptive (ie, mean, standard deviation, and frequency distribution) and inferential (ie, t-test, Pearson, and ANOVA) statistics were used to describe the data. All the ETT cuff pressure measurements were performed with a calibrated manometer. The data were analyzed using the SPSS software, version 22.0.
 
Results: The mean ETT cuff pressure was 38.3 ± 24.9 cmH2O. In the first measurement, the ETT cuff pressure was normal in only 17% of the subjects, while this figure increased to 78% after the 6-hour control period and cuff-pressure correction. There was a significant relationship between the number of days of intubation and the ETT cuff pressure in both first (P = 0.003) and second (P = 0.01) measurements.
 
Conclusions: The ETT cuff pressure often exceeds the recommended normal range, which can serve as a reminder that it may be necessary to control it at shorter intervals to avoid complications caused by increases or decreases in the cuff pressure. (Iranian Heart Journal 2020; 21(3): 33-39)

Keywords


  1. Aeppli N, Lindauer B, Steurer MP, Weiss M, Dullenkopf A. Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in-vitro assessment. Acta Anaesthesiologica Scandinavica. 2019 Jan; 63(1):55-60.
  2. Golaghaie F, Momeni R, Jafarimanesh H, Golestanieraghi M, Golitaleb M, Rafiei F. Impact of Stylet Bend Angle on the Performance of Orotracheal Intubation by Emergency Response Nurses: A Randomized Simulation Study. Eurasian Journal of Emergency Medicine. 2018 Jun 1; 17(2):45-9.
  3. Hu J, Yu L, Jiang L, Yuan W, Bian W, Yang Y, Ruan H. Developing a Guideline for Endotracheal Suctioning of Adults With Artificial Airways in the Perianesthesia Setting in China. Journal of PeriAnesthesia Nursing. 2019 Feb 1;34(1):160-8.
  4. Dadure C, Sabourdin N, Veyckemans F, Babre F, Bourdaud N, Dahmani S, De Queiroz M, Devys JM, Dubois MC, Kern D, Laffargue A. Management of the child's airway under anaesthesia: The French guidelines. Anaesthesia Critical Care & Pain Medicine. 2019 Feb 23.
  5. Wen Z, Wei L, Chen J, Xie A, Li M, Bian L. Is continuous better than intermittent control of tracheal cuff pressure? A meta-analysis. Nursing in critical care. 2019 Mar; 24(2):76-82.
  6. mousavi S A J, niakan lahiji M, akhovatian F, moradi moghadam O, valizade hassanlouei M A. An Investigation of endotracheal Tube cuff Pressure. Daneshvar Medicine. 2009; 17 (83) :43-48 URL: http://daneshvarmed.shahed.ac.ir/article-1-39-fa.html
  7. Mishra R, Singh M, Mahobia M. Maintaining optimal endotracheal tube cuff pressure with pressure gauge reduces the frequency of postoperative airway complications during endoscopic cervical spine surgery. Anaesthesia, Pain & Intensive Care. 2019 Jan 19:442-6.
  8. Mishra R, Singh M, Mahobia M. Maintaining optimal endotracheal tube cuff pressure with pressure gauge reduces the frequency of postoperative airway complications during endoscopic cervical spine surgery. Anaesthesia, Pain & Intensive Care. 2019 Jan 19:442-6.
  9. Chang E, Wu L, Masters J, Lu J, Zhou S, Zhao W, Sun M, Meng F, Soo CP, Zhang J, Ma D. Iatrogenic subglottic tracheal stenosis after tracheostomy and endotracheal intubation: A cohort observational study of more severity in keloid phenotype. Acta Anaesthesiologica Scandinavica. 2019 Apr 14.
  10. Sousa AS, Ferrito C, Paiva JA. Application of a ventilator associated pneumonia prevention guideline and outcomes: A quasi-experimental study. Intensive and Critical Care Nursing. 2019 Apr 1;51:50-6.
  11. Sole ML, Poalillo FE, Byeres JF, Ludy JE. Bacterial Growth in Secretions and on Suctioning Equipment of Orally Intubated Patients: A Pilot Study. Am J Crit Care. 2002; 11:141-149.
  12. Blot S, Rello J, Vogelaers D. What is new in the prevention of ventilator associated pneumonia? Curr Opin Pulm Med 2011;17(May (3)):155–9, http://dx.doi.org/10.1097/mcp.0b013e328344db65.
  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 Anesthesiology.2004;4:8.
  14. 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: 133-143.
  15. 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 Mar;26(3):229-34.
  16. American Thoracic Society, Infectious Diseases Society of America.  Guidelines for The Management of Adults with Hospital Acquired, Ventilator-Associated, And Healthcare- Associated Pneumonia. Am J Respire Crit Care Med. 2005; 171(4):388-416.
  17. Corda DM, Robards CB, Rice MJ, Morey TE, Gravenstein N, Vasilopoulos T, Brull SJ. Clinical application of limiting laryngeal mask airway cuff pressures utilizing inflating syringe intrinsic recoil. Rom J Anaesth Intensive Care. 2018 Apr;25(1):11.
  18. Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, Dulhunty J, Blot S. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Car. 2014 Jan 1;23(1): e1-8.
  19. Golitaleb M, Kargar F, Aghai FG, Harorani M, Jadidi A, Abkenar HB, Haghazali M. Hyperbilirubinemia after open cardiac surgery. Iranian Heart Journal. 2017;18(2):30-5.
  20. Golitaleb M, Golaghaie F, mousavi MS, Harorani M, Abkenar HB, Haghazali M, Mashayekh A. Gastrointestinal Complications After Cardiac Surgery.Iranian Heart Journal. 2019;20(2):56-61.
  21. Rose L, Redl L. Survey of Cuff Management Practices in Intensive   Care   Units in Australia and New Zealand. Am J Crit Care. 2008; 17(5):428-435.
  22. Stwart S, Secrest JA, Norwood BR, Zachary R. A Comparation of Endotracheal Tube Cuff Pressure Using Estimation Techniques and Direct Intracuff Measurement. AANA J. 2003; 71(6): 443-447.
  23. Zand F, Nekooeian A, Rohani M. Endotracheal Tube Cuff Pressure Monitoring in Intensive Care Unit Iran Red Crescent Med J e.2008; 10(3):223-227.
  24. Hoffman RJ, Parwani V, Hahm I.  Experienced Emergency Medicine Physicians Cannot Safety Inflate or Estimate Endotracheal Tube Cuff Pressure Using Standard Technique. Am J Emerg Med.2006; 24(2): 139-143.
  25. Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, et al. Correlations Between Controlled Endotracheal Tube Cuff Pressure and Post Procedural Complications: A Multicenter Study. Anesth Analg. 2010 Nov;111(5): 1133-7. doi:10.1213/ANE.0b013e3181f2ecc7. Epub 2010 Aug 24.
  26. Hamilton VA, Grap MJ. The   Role of the Endotracheal Thbe Cuff in Micro aspiration. Heart & Lung. 2011; 41:167-172.
  27. Sadeghi F, Golitaleb M, Totonchi Z, Harorani M, Azarfarin R, BakhshandeAbkenar H. Factors Influencing a Prolonged ICU Stay After Coronary Artery Bypass Graft Surgery: A Cross-sectional Study. Iranian Heart Journal.;20(4):85-91