Safeguarding Pediatric Airways: A Closer Look at Cuff Pressure Control

Abstract

Background: Proper insufflation of the tube cuff is critical in pediatric endotracheal intubation. However, the widespread use of subjective techniques for measuring cuff pressure by healthcare workers has raised concerns due to the potential for airway damage and subsequent impact on laryngotracheal tissue. Objective: This study aims to evaluate tube cuff pressure variations based on operator expertise and clinical context among pediatric patients undergoing endotracheal intubation and compare the measurements obtained through subjective techniques with those obtained using an objective method involving a manometer. Methods: This cross-sectional observational quantitative study obtained Institutional Ethics Committee approval and was conducted between October 2022 and January 2023. Descriptive statistics and frequency distributions were used for variable characterization. The Kolmogorov-Smirnov test assessed normality. A bivariate analysis employed chi-square tests and ANOVA, establishing a 95% confidence interval and significance level at p < 0.05. Results: Seventy pediatric patients (mean age: 7.53 years) participated. Anesthesiology residents primarily performed intubation (28.6%), while tube cuff inflation was predominantly executed by nursing staff (38.6%), except within the intensive care unit where respiratory therapists assumed responsibility (20%). Manometric measurements indicated an average tube cuff pressure of 30.8 cm H2O (SD 17.4) across all scenarios. Notably, higher pressures were recorded in emergency contexts, with a statistically significant correlation between cuff pressure and insufflation personnel (P < 0.001), particularly evident when nursing staff was involved, with a mean difference of up to 18 cm H2O (P < 0.001). A statistically significant link existed between pressure levels and clinical context (P = 0.030). Conclusion: This study underscores the discord between cuff pressures when measured by subjective techniques, highlighting the importance of objective manometric measurements. There is a necessity for comprehensive training of healthcare professionals working in surgical, emergency, and pediatric intensive care units, enabling them to proficiently utilize manometers for precise pressure evaluations that limit the risk of injury due to high pressures or aspiration and subsequent ventilator-associated pneumonia due to inadequate inflation.