Endotracheal tube cuff pressure monitoring in intensive care units

Background: Improper inflation of endotracheal tube cuff is associated with various complications. Recently, there has been high referral of patients with post-intubation complications to the clinics affiliated to Shiraz University of Medical Sciences. Herein, we examined the practice of cuff pressure monitoring at 9 adult intensive care units in 3 university-affiliated hospitals. Methods: The present study was performed on 57 tracheally intubated patients, whose cuff pressures were measured using either a cuff pressure gauge on 12 patients (Group 1) or manual palpation of the pilot balloon on 45 cases (Group 2) during summer 2004. The intracuff pressure (P1), intracuff volume (V1), and pressure exerted by the cuff against the tracheal mucosa (ΔP) were determined., analyzed and compared with the recommended values. Results: The P1 in Group 1 was 35.3 ±32.8 SD cmH2O, with 33.3% of the patients having values below 20 cmH2O. In group two, P1 was 88.8±27.1 cmH2O, all of which being above 40 cmH2O. The ΔP for the Groups 1 and 2 were 16.3 ±11.1SD cm H2O and 35.5 ±15.6 cm H2O, respectively. Conclusion: Our findings indicated that manual palpation of balloon cuff to monitor cuff pressure was not an accurate procedure. They also suggested that measures to increase the knowledge and skills of ICU staff and posting of cuff pressure monitoring protocols might help improve the practice.