Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patientsReport as inadecuate




Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patients - Download this document for free, or read online. Document in PDF available to download.

BMC Anesthesiology

, 15:147

First Online: 15 October 2015Received: 19 April 2015Accepted: 08 October 2015

Abstract

BackgroundMaintaining the cuff pressure of endotracheal tubes ETTs within 20–30 cmH2O is a standard practice. The aim of the study was to evaluate the effectiveness of standard practice in maintaining cuff pressure within the target range.

MethodsThis was a prospective observational study conducted in a tertiary-care intensive care unit, in which respiratory therapists RTs measured the cuff pressure 6 hourly by a handheld manometer. In this study, a research RT checked cuff pressure 2–4 h after the clinical RT measurement. Percentages of patients with cuff pressure levels above and below the target range were calculated. We identified predictors of low-cuff pressure.

ResultsWe analyzed 2120 cuff-pressure measurements. The mean cuff pressure was 27 ± 2 cmH2O by the clinical RT and 21 ± 5 cmH2O by the research RT p < 0.0001. The clinical RT documented that 98.0 % of cuff pressures were within the normal range. The research RT found the cuff pressures to be within the normal range in only 41.5 %, below the range in 53 % and above the range in 5.5 %. Low cuff pressure was found more common with lower ETT size OR, 0.34 per 0.5 unit increase in ETT size; 95 % CI, 0.15–0.79 and with lower peak airway pressure OR per one cm H2O increment, 0.93; 95 % CI, 0.87–0.99 on multivariate analysis.

ConclusionsCuff pressure is frequently not maintained within the target range with low-cuff pressure being very common approximately 3 h after routine measurements. Low cuff pressure was associated with lower ETT size and lower peak airway pressure. There is a need to redesign the process for maintaining cuff pressure within the target range.

KeywordsIntensive care Aspiration Respiratory therapy Intratracheal intubation AbbreviationsCIConfidence interval

EDEmergency Department

ETTEndotracheal tube

ICUIntensive care unit

OROdds ratio

RTRespiratory therapist

VAPVentilator associated pneumonia

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Author: Amer R. Alzahrani - Shatha Al Abbasi - Othman Khalid Abahoussin - Tariq Othman Al Shehri - Hasan M. Al-Dorzi - Hani M. 

Source: https://link.springer.com/







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