Abstract
BackgroundTracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria.MethodsThis was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 tertiary hospitals in Nigeria, selected by stratified random sampling.ResultsOnly 3.1% (6/196) of the care providers admitted having ever used a tracheal cuff manometer, while 31.1% knew the recommended tracheal cuff pressure. The nationwide telephone survey of anaesthesia faculty fellows revealed that tracheal cuff manometer is neither available, nor has it ever been used in any of the 13 tertiary hospitals surveyed. The ‘Pilot balloon palpation method’ and ‘fixed volume of air from a syringe’ were the most commonly utilized method of cuff pressure estimation by the care providers, at 64.3% and 28.1% respectively in part A survey (84.6% and 15.4% respectively, in the part B survey).ConclusionThe use of tracheal cuff manometer is very limited among the care providers surveyed in this study. Knowledge regarding tracheal cuff management among the providers is adjudged to be fair, despite the poor practice and unsafe care.
Highlights
Tracheal tubes are routinely used during anaesthesia and in the intensive care unit
The tracheal tubes commonly used in anaesthesia, emergency departments and critical care are equipped with cuffs to protect the lower airway from gastric aspiration and other forms of sub-glottic contamination
The European task force, the American thoracic society and Infectious diseases society of America (ATS-IDSA) guidelines have since recommended cuff pressure (Pcuff ) regulation as a measure for controlling ventilator-associated pneumonia in the intensive care unit (ICU) [7]
Summary
Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. This practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria. The European task force, the American thoracic society and Infectious diseases society of America (ATS-IDSA) guidelines have since recommended cuff pressure (Pcuff ) regulation as a measure for controlling ventilator-associated pneumonia in the intensive care unit (ICU) [7]. The bulkiness and requirement for electricity in these automated continuous regulation devices may have impacted adversely on their widespread use in clinical practice
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