Tracheal cuff pressure change before and after the performance of nursing care.

Lúcia Marinilza Beccaria,Alexandre Lins Werneck,Tais Pagliuco Barbosa,Daniele Cristiny Da Silva,Nádia Aparecida Antonia Polletti,Thays Marley Antonio Doimo

doi:10.1590/0034-7167-2016-0486

Lúcia Marinilza Beccaria, Alexandre Lins Werneck + Show 4 more

Open Access

https://doi.org/10.1590/0034-7167-2016-0486

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Abstract

Verify the changes of endotracheal cuff pressure before and after oral hygiene, head-of-bed elevation at 0º, 30º, and 60º, change in body position, aspiration of the endotracheal tube, and in-bed bathing. The study sample was composed of 88 patients. We performed 3,696 checks from July to September 2014. Pressure values were analyzed in seven nursing care in the morning. Six of them were significantly altered before and after nursing procedure. In the afternoon, five of the health care provided were altered, and in the evening, only two. Most of pressure values were below recommended. There were differences before and after health care provided, showing changes in cuff pressure. In-bed bathing and head-of-bed elevation at 30º were the ones that most altered pressure values in the three working shifts. Therefore, it is necessary to measure cuff pressure at least twice per working shift, preferably after bathing.

Highlights

Tracheal intubation with a cuffed tube is considered definitive airway management in adults
Dysphagia, and/or dysphonia are reported in approximately 50% of cases
Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure

Summary

Introduction

Tracheal intubation with a cuffed tube is considered definitive airway management in adults. The tube cuff is designed to provide a seal against aspiration and to prevent leaks during positive pressure ventilation(1-3). Hemodynamic instability, hypoxemia and acidosis in ICU patients indicate the need for maintaining a secure airway for these patients(3). The endotracheal tube cuff should remain inflated in order to prevent gas leakage and aspiration of oropharyngeal contents into the lungs(4). Clinical complications range from a mild sore throat to tracheoesophageal fistula, tracheocarotid artery erosion, tracheal stenosis, and even tracheal rupture(1). Emergent intubation, and medication in ICU bring the high risk of intubation complications as high as 54%(3). Cough can be more problematic, leading to hemodynamic alterations, arrhythmias, increase in intraocular and intracranial pressures, bronchospasm, and postoperative surgical complications. The incidence of cough at emergence ranges from 40 to 96%(5)

Results

Discussion

Conclusion