Practicing Paramedics Cannot Generate or Estimate Safe Endotracheal Tube Cuff Pressure Using Standard Techniques

Abstract

Objectives. We sought to determine the ability of paramedics to inflate endotracheal tube cuffs within safe pressure limits as well as to estimate the pressure of previously inflated endotracheal tube cuffs by palpation of the pilot balloon. Methods. Using a tracheal simulation model, we conducted a prospective, observational, cross-sectional simulation study of licensed, practicing paramedics. This included evaluation of their ability to inflate the cuff of an endotracheal tube to a safe pressure, defined as ≤ 25 cm H2O, as well as to identify excessive intracuff pressure in previously inflated ETT cuffs by palpation of the pilot balloon. Results. Fifty-three paramedics were sampled. The average pressure generated by inflating the endotracheal tube cuff was > 108 cm H2O. Participants were only 13% sensitive detecting over inflated endotracheal tube cuffs (95% CI 7.3–17.8). Conclusions. Participants were unable to inflate endotracheal tube cuff to safe pressures andwere unable to identify endotracheal tube cuffs with excessive intracuff pressure by palpation. Clinicians should consider using devices such as manometers to facilitate safe inflation andaccurate measurement of endotracheal tube cuff pressure.