Intraoperative cuff pressure measurements of endotracheal tubes in the operating theater: A prospective audit

Abstract

Background: Endotracheal tube (ETT) intracuff pressure (PINTRACUFF) monitoring is not a mandatory part of daily anesthetic practice in many countries. Correct PINTRACUFF is required to ensure adequate ventilation, to prevent aspiration, and to avoid complications. The aim of this study was to objectively measure the PINTRACUFF in ETTs among patients from an Australian tertiary hospital to define the range of PINTRACUFF values seen in a setting without the use of routine objective monitoring. Patients and Methods: A prospective single-center audit of PINTRACUFF of 268 elective and emergency surgical patients undergoing general anesthesia with an ETT was performed. PINTRACUFF values were measured with a calibrated cuff manometer following the induction of anesthesia. Patient characteristics were compared between three patient groups of measured PINTRACUFF values: 20 cmH2O, 20–30 cmH2O, and >30 cmH2O. Results: To estimate the PINTRACUFF, only the auditory method was used among 66.0% of the patients, the tactile method was used in 18.3%, and the remainder used both or other methods. Following induction of anesthesia, the mean PINTRACUFF was 31.0 cmH2O (±standard deviation 16.4). The PINTRACUFF was 30 cmH2O had a marginally higher body mass index (BMI) compared to patients with a PINTRACUFF <30 cmH2O (P = 0.002). Patients with higher BMIs and smaller ETTs had higher cuff pressures. Conclusion: This study demonstrates that replacing subjective estimation methods with mandatory cuff pressure measurement can ensure that normal values are achieved during anesthesia.

Keywords

• airway management
• endotracheal tube
• equipment cuffs
• monitoring anesthesia
• monitoring cuff pressure