Development of appropriate procedures for inflation of endotracheal tube cuff in intubated patients

Abstract

Background: Hyperinflation of endotracheal tube cuff causes tracheal mucosal damage and underinflation increases the risk of pneumonia. The current practice on inflation of endotracheal tube cuff in the intubated patients hospitalized at Siriraj Hospital uses the estimation method. The authors determined appropriateness of such current practice and developed an appropriate procedure for inflation of endotracheal tube cuff in intubated patients. Material and Method: The endotracheal tube cuff pressures of 34 intubated patients in Siriraj Hospital were measured by manometer once daily. Inflation of the endotracheal tube cuffs of 20 patients was done and the volume of air required to optimize the intracuff pressure of 25 cmH2O was recorded. The intracuff pressure was measured every one hour for eight consecutive hours in the patients who had initial intracuff pressure of 25 cmH2O and 30 cmH2O. The nurses in the experimental wards used a manometer as a guide to inflate endotracheal tube cuff until the intracuff pressure was 30 cmH2O every eight hours, whereas the control wards used conventional procedures to inflate the endotracheal tube cuff. The endotracheal tube cuff pressures of the patients in both groups were measured twice daily. Results: Only 34% of intracuff pressure measurements were 20-30 cmH2O. The mean volume of inflated air required to achieve an intracuff pressure of 25 cmH2O was 7.1 ml. An initial intracuff pressure of 30 cmH2O decreased to 20 cmH2O at 7 to 9 hours after inflation. The rate of optimum endotracheal tube cuff pressure was 90.5% in the group guided by manometer and 31.8% in the conventional procedure group (p < 0.001, RR 2.85, 95% CI 2.44-3.32). Conclusion: Inflation of endotracheal tube cuff should be guided by manometer to achieve a pressure of 30 cmH2O every eight hours.