Accuracy of Endotracheal Tube Cuff Pressure Adjustment by Fingertip Palpation after Training of Intensive Care Unit Nurses

Background: Untrained fingertip palpation has been shown to be unable to adjust endotracheal tube (ET) cuff pressure in most intubated patients. Objective: We determined the impact of a training course of ETT cuff adjustment by palpation in attaining a safe cuff inflation pressure. Patients and Methods: Twenty-five nurses were asked to adjust the ETT cuff pressure to 25 cmH2O by palpation on three different patients in seven sessions (S1-S7): before training, two hours and two days after first training session, and two hours, two days, one week, and eight months after second training session. Results: Before training, 41.3% of the cuff pressures were adjusted to the safe range of 21-35 cmH2O. The pressures obtained in S2-S7 were lower and less variable than S1 (P = 0.02 to < 0.0001). After the first training session, all the ETT cuff pressures in the high range (36-50 cmH2O) and 87.5% in the very high range (> 50 cmH2O) changed to the safe range. Conclusions: Using trained fingertip adjustment of the ETT cuff pressure throughout the nursing shift with protocols for the adjustment of out of range pressures at the beginning of each shift by cuff manometer could decrease the rate of ETT cuff over- and under-inflation.