Abstract
Background: Maintenance of optimal Endotracheal Tube cuff Pressure (ETTcP) in anaesthetic practice reduces cuff pressure complications. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH). It also evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient’s age, weight and height on this volume. Methods: Eighty-one patients who underwent general anaesthesia were recruited. ETTcP was measured using an aneroid manometer via a three-way tap. After full cuff deflation, the cuff was refilled with air until an ETTcP of 20 cm H2O was obtained. Independent t-test was used to measure the statistical variations in the ETTcP using estimation techniques in relation to recommended levels as well as the significant difference of mean VAR to obtain a cuff pressure of 20 cm H2O. Grouped t-test was used to determine significant differences in ETTcP between anaesthesia providers using estimation techniques. Results: Mean ETTcP obtained from estimation techniques was (61.87, 73.79) cm H2O. The mean ETTcP measured for Physician and Nurse Anaesthetists were 65.36 cm H20 and 69.52 cm H2O respectively. The mean VAR to achieve an ETTcP of 20 cm H2O for endotracheal tube sizes 7.0 mm and 8.0 mm were 3.90 ± 1.13 mls and 4.55 ± 0.95 mls respectively. Age and weight significantly influenced the VAR to achieve a cuff pressure of 20 cm H2O, however, height did not. Conclusions: This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers. However, in the absence of an aneroid manometer, ETTcP of tube sizes 7.0 mm and 8.0 mm can be safely approximated to the recommended levels with predetermined inflation volumes.
Highlights
General anaesthesia with endotracheal intubation and mechanical ventilation is utilized in many surgical procedures to maintain adequate ventilation for the patient
This study demonstrated that cuff pressures obtained by estimation techniques were generally higher than the recommended average with no significant difference between anaesthesia providers
Percentages of endotracheal tube cuff pressure measured after intubation by anaesthesia providers for various ranges
Summary
General anaesthesia with endotracheal intubation and mechanical ventilation is utilized in many surgical procedures to maintain adequate ventilation for the patient. Cuff pressures greater than 30 cm H2O are known to obstruct tracheal capillary blood flow with total occlusion of flow occurring at pressures above 50 cm H2O [3] Both excessive and under inflation of endotracheal tube cuffs have adverse complications [4]-[8]. This, not withstanding, is notable that most clinicians give little attention to inflation pressure of the endotracheal tube cuff, and determine the cuff pressure by estimation techniques according to their experience. The study assessed ETTcP obtained from estimation techniques between anaesthesia providers at Korle-Bu Teaching Hospital (KBTH) It evaluated the Volume of Air Required (VAR) to obtain an acceptable cuff inflation pressure for sizes 7.0 and 8.0 mm adult endotracheal tubes used at the hospital, and the effect of patient’s age, weight and height on this volume.
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