Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon?

Abstract

Background. Over the past 5 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes in infants and children. However, there has been limited attention to techniques to ensure a safe intracuff pressure. We sought to determine the accuracy of estimating endotracheal tube intracuff pressure by palpation of the pilot balloon by anesthesiologists, anesthesia residents, pediatric anesthesia fellows, certified nurse anesthetists, and student nurse anesthetists. Methods. A tracheal simulation model was constructed with 3 different diameters of polyvinylchloride tubing. Three different-sized endotracheal tubes (4.0, 5.0, and 6.0 mm) were then placed into the tubes and the cuffs inflated to various pressures. Each participant was given 3 different scenarios of cuff pressure for each endotracheal tube size for a total of 9 scenarios per practitioner. By feeling the pilot balloon, the anesthesia provider was asked to estimate whether the cuff pressure was greater than 30 cm H2O, 20 to 30 cm H2O, or less than 20 cm H2O. The cuff pressure was then measured using a manometer to determine whether they had correctly estimated the intracuff pressure. Results. A total of 106 anesthesia providers participated in the study. Participants were able to estimate the correct intracuff pressure with palpation of the pilot balloon 45% of the time. In the remaining cases, the intracuff pressure was overestimated 29.4% of the time and underestimated 25.7% of the time. The intracuff pressure was correctly identified 44.4% of the time by attending physicians, 55.67% of the time by anesthesia residents or fellows, 50.6% of the time by certified nurse anesthetists, and 38.4% of the time by student nurse anesthetists. Conclusion. Participants from all the groups were unable to reliably estimate endotracheal intracuff pressure from palpation of the pilot balloon. Given the potential injury from excessive intracuff pressures, other techniques are necessary to ensure that excessive pressures are not present.