Endotracheal tube cuff inflation pressure varieties and response to education among anesthetists

Abstract

ABSTRACT Background This study aimed to evaluate endotracheal tube (ETT) cuff inflation pressure (CIP) applied by anesthetists as well as the effect of an interview and feedback on their CIP accuracy. Methods This single-blind, controlled trial involved two series of CIP measurements in intubated patients before and after an interview and feedback of the participating anesthetists who were asked to inflate the cuffs for all intubated patients as per their clinical judgment. The cuff pressures were measured using a manometer and accordingly adjusted to 25 cm H2O by the researchers. For each anesthetist, 3 measurements were recorded, and the mean pressure values were calculated for each setting. The anesthetists were initially blinded, then they were informed about the pressure values and the adjustments. The primary outcome was the anesthetists’ accuracy regarding ETT inflation following the feedback. The secondary outcomes were pressure values in senior and junior anesthetists as well as in scheduled and emergency operations. Results The study enrolled 28 anesthetists; six registrars or senior registrars and 22 residents. Interview and feedback significantly lowered the mean pressure applied by the anesthetists. The cuff inflation pressure decreased from 33.8 ± 1.95 to 30.8 ± 3.24 and from 32.9 ± 2.38 to 29.9 ± 3.44 for emergency and scheduled surgeries, respectively. Furthermore, the frequency of safe CIP increased significantly for both emergency and scheduled surgeries. However, the senior staff showed no significant increase in safety CIP. Conclusion Anesthetists improved their accuracy of CIP after educational feedback. ETT cuff pressures should be routinely measured in intubated patients under general anesthesia.