The impact of routine intensive care procedures on the endotracheal tube cuff pressure

Abstract

Background: During mechanical ventilation the endotracheal tube (ETT) cuff pressure should be maintained in the range of 20-30 cmH 2 O to prevent ETT - related complications. ETT - cuff underinflation increases the risk of aspiration of oropharyngeal secretions and air leakage, while overinflation increases the risk of tracheal wall damage. Aims: To assess the impact of changes in body position and routine intensive care unit (ICU) procedures (endotracheal suctioning and bronchoscopy) on ETT - cuff pressure. Methods: Twelve critically ill adult patients were included in the study. All patients were orally intubated and mechanicaly ventilated by pressure controle mode. Cuff pressure was set to 25 cmH 2 O in each patient while in neutral position (supine, head of the bed elevated to 40 o ). Cuff pressures were measured after right and left lateral patient positioning, closed endotracheal suctioning and bronchoscopy. Results: The cuff pressure, on average, decreased after right and left lateral patient positioning by 7.83 (p 2 0 (p 2 O (p 2 O (p 2 O. Conclusions: Routine ICU procedures and changes of body positions significantly impact the ETT cuff pressure in patients receiving mechanical ventilation. To reduce ETT – related complications, cuff pressure measurement should be performed after every procedure. To maintain cuff pressure in the optimal range, the continuous endotracheal cuff pressure control system could be used.