Measurement Of Endotracheal Tube Cuff Pressure Research Articles

Effect of Body Position Changes on Endotracheal Tube Cuff Pressure Measurements for Mechanically Ventilated Patients

Effect of Body Position Changes on Endotracheal Tube Cuff Pressure Measurements for Mechanically Ventilated Patients

Effect of Shallow versus Deep Suctioning Techniques on Endotracheal Tube Cuff Pressure Measurements and Physiological Indices among Patients Undergoing Mechanical Ventilation

Effect of Shallow versus Deep Suctioning Techniques on Endotracheal Tube Cuff Pressure Measurements and Physiological Indices among Patients Undergoing Mechanical Ventilation

Comparison between Endotracheal Tube Cuff Pressure Measurements Before and After nursing Interventions among Mechanically Ventilated Patients

Comparison between Endotracheal Tube Cuff Pressure Measurements Before and After nursing Interventions among Mechanically Ventilated Patients

Analysis of endotracheal tube cuff pressure measurements and incidence of ventilator associated pneumonia

Cuff pressure is essential in endotracheal tube management. Guidelines recommend a cuff pressure of 20 to 30 cm H2O. Subinflation of the cuff puts patients at risk for micro-aspiration of subglottic secretions. This micro-aspiration is considered the major pathogenic mechanism for ventilator-associated pneumonia, complication with marked morbidity and mortality. Aim: This study was carried out to determine the correlation of endotracheal tube cuff pressure and the incidence of ventilator-associated pneumonia. Design: Descriptive research design. Setting: In two critical care units at Assiut Main University Hospital: Trauma ICU and general ICU. Subjects: A convenience sample of 60 critically ill patients. Tools: Three tools were utilized to collect data of study, Tool I: Patient assessment sheet. Tool II: Endotracheal tube cuff pressure measurements. Tool III: Ventilator- associated pneumonia assessment sheet. Method: The researcher used preparatory, implementation and evaluation phases to implement this study. Results: Finding of the present study revealed that there was significant statistical relationship between endotracheal tube cuff pressure and incidence of ventilator associated pneumonia (P value < 0.05). Conclusion: There is a significant statistical relationship between endotracheal tube cuff pressure and incidence of ventilator associated pneumoniaed as a basic part of care provided to all critically ill patients in intensive care units.

Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES).

ObjectiveTo study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment.Materials and methodsThis was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg.ResultsOut of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables.ConclusionOur findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098).Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737How to cite this articleShaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, et al. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181–184.

A mobile terminal application program was used for endotracheal tube cuff pressure measurement.

We studied the application of a mobile terminal application program in endotracheal tube (ETT) cuff pressure measurement to improve the implementation rate of scientific ETT cuff pressure measurement and to ensure that the pressure falls within the recommended range. A pre-post controlled study lasting for 18 months was undertaken in a 40-bed general intensive care unit (GICU). This included a 6-month baseline period (baseline group) and a 6-month intervention period (intervention group). The mobile terminal application program was applied to monitor the cuff pressure of endotracheal intubation as an intervention measure during the intervention period. ETT pressure was the main outcome measure, while gender, age, causes for ICU admission, sedation score, duration of prior intubation, size of ETT, and number of VAP patients were secondary outcomes. ETT cuff pressure was monitored 742 times in both the baseline group and the intervention group. A total of 56.9% of the cuff pressure measurements in the baseline group were within the recommended range, while 78.4% of measurements in the intervention group were within the recommended range, reflecting a statistically significant difference (P < 0.05). The application of the mobile terminal application program used for ETT cuff pressure measurement could improve the percentage of ETT cuff pressure measurements falling within the recommended range.

Comparison of endotracheal cuff pressure measurements before and after nursing care in emergency patients: pilot balloon palpation

Background: Manual inflation of tracheal tube cuff after intubation is necessary to provide a safe airway in intubated patients. An increase or decrease in the pressure of cuff balloon leads to serious complications such as mucosal necrosis and micro aspiration. The aim of the study was to compare the endotracheal tube cuff pressure measurements before and after selected nursing care in emergency patients underwent pilot balloon palpation during cuff inflation. Methods: A prospective cross-sectional design was utilized in the emergency department at Al Manial University Hospital upon a convenient sample of 100 mechanically ventilated patients from April 2016 to June 2017. Demographic and medical data were collected. Later, the endotracheal cuff pressure was checked with manometer before and 15 minutes after each nursing intervention and data were analyzed using SPSS software version 20. Results: The majority of the studied sample was male with mean age 47.09 ± 15. Significant differences were detected regarding Endotracheal suctioning (t=16.99, p=0.000), Changing body position (t=2.76, p=0.026) and sedating patients (t=3.951, P ≤ 0.0001). As changing patients’ body position to lateral sides, performing endotracheal and applying sedation caused a significant decrease in cuff pressure 15 minutes after. Conclusion: ETT cuff pressure was affected significantly with medical and nursing procedures and the pilot balloon palpation volume method was not suitable to estimate cuff pressure during intubation and the cuff pressure must be monitored and controlled by the manometers.

Effect of patient position on endotracheal cuff pressure in mechanically ventilated critically ill patients

BackgroundEndotracheal tube cuff pressure must be maintained within 20–30mH2O to prevent complications. There is limited literature reporting the impact of nursing care on endotracheal cuff pressure. However, few studies have reported the effect of nursing care on endotracheal cuff pressure. ObjectivesThis study was performed to investigate the effects of body position on endotracheal cuff pressure. MethodsTwenty-five patients receiving mechanical ventilatory therapy were placed in a baseline position (semirecumbent position with the head of the bed elevated at 30° and head in a neutral position) with endotracheal tube cuff was adjusted to 25cmH2O. The patients were moved into 16 different positions: anteflexion of the head; hyperextension of the head; left lateral flexion of the head; right lateral flexion of the head; rotation of the head to the left; rotation of the head to the right; semirecumbent position with 45° elevation of the head of the bed; recumbent position with 10° elevation of the head of the bed; supine position; trendelenburg position 10°; left lateral position at 30°, 45°, and 90°; and right lateral position at 30°, 45°, and 90°. The endotracheal tube cuff pressure was measured and recorded after each position change. ResultsAmong the 400 endotracheal tube cuff pressure measurements (25 patients×16 positions) 10 (2.5%) were lower than 20cmH2O; 201 (50.3%) were between 20–30cmH2O and 189 (47.3%) were higher than 30cmH2O. Mean endotracheal tube cuff pressure increased from 25 to 32.59±4.08cmH2O after changing the patients’ position. Friedman test indicated a statistically significant deviation in the ETCP across the 16 positions (X2: 122.019, p: 0.0001). ConclusionsBody positioning during daily nursing care effected the endotracheal tube cuff pressure, suggesting that endotracheal tube cuff pressure should be measured after changing a patient’s position and adjusted within the recommended range.

387

Introduction: Endotracheal tube (ETT) cuff pressure must be kept less than 30 cm H2O to prevent tracheal wall pressure necrosis, but must maintain an adequate seal for ventilation. Manometry and a minimal leak test (MLT) are both well-described methods for measuring cuff pressure. Methods: During a 2 month period, we used a manometer to obtain initial ETT cuff pressure measurements on all mechanically ventilated patients in a surgery ICU. Two different physicians then separately performed a MLT for each patient and measured the corresponding cuff pressure; these were compared between the two physicians. The VAP rate per ventilator days were calculated for the two months during the study period and compared to the two months immediately prior to the study. Results: Twenty-eight patients were included for a total of 50 events. The post-MLT measured cuff pressures by the two physicians were highly consistent, with an intraclass correlation coefficient of 0.872 (95% CI). The post-MLT measured cuff pressures were greater than 30 cm H2O in only 2 cases (4%; avg 32 cm H2O). During the first half of the study, the incidence of starting cuff pressures elevated above 30 cm H2O was not significantly different than the second month (19% vs 31%, p = 0.38); however, of the patients with elevated cuff pressures, the mean and elevation above the norm were both higher (47.5 ± 7.724 vs 38.89 ± 5.302 cm H20 and 17.5 ± 7.724 vs 8.89 ± 5.302 cm H20, p = 0.037). There was no difference in VAP rate during the study compared to historical controls (2.79 vs 2.99 VAPs per 1000 ventilator days, p = 0.961). Conclusions: The incidence of ventilator-associated pneumonia is not significantly increased due to the performance of a daily MLT. The MLT is a reliable indicator of endotracheal cuff pressure, does not undergo significant inter-observer subjective variation, and produces cuff pressures consistently within the acceptable range of less than 30 cm H2O. Additionally, we suspect that by emphasizing safe cuff pressures and daily cuff measurements during the course of our study we were able to decrease unacceptably high starting endotracheal cuff pressures.