Related Article: Paramedics overinflate endotracheal tube cuffs
A recent study published in Prehospital Emergency Care investigated whether or not paramedics could determine appropriate inflation of endotracheal tube cuffs. The study found that none of the 53 participants were able to determine appropriate cuff pressure by palpation of the pilot balloon. Endotracheal tube cuff pressures should not exceed 25mm Hg and 66 percent of the intubations resulted in cuff pressures over 120mm Hg.
So what is the appropriate way to determine optimal endotracheal tube cuff pressure? Although cuff pressure should be checked in the hospital setting, there is good documentation that this is not the case. Paramedics can help alleviate potential long-term complication with just a little extra attention to cuff pressure.
- Gold Standard — Using a commercially manufactured manometer is the best method and should be administered in a hospital setting.
- Field Options — Use the minimum pressure required to stop cuff air leakage. When the patient is transferred to the ER staff, mention your concern about the cuff pressure to the respiratory therapist, anesthesiologist, nurse or ER physician if you think it may not be optimal.
High endotracheal tube cuff pressures can result in tissue necrosis and vocal cord paralysis. Paramedics and prehosptial personnel are just one group of healthcare professionals that have a responsibility with this multi-practitioner issue. Why not add endotracheal cuff pressure to the post-intubation checklist? Here are the guidelines: (1) auscultation (2) EtCO2 (3) depth of tube and (4) endotracheal cuff pressure.
References
- Parwani, V et al. Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques. Prehosp Emerg Care. 2007 Jul-Sep; 11(3):307-11.
- Sengupta, P et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiology. 2004, 4:8 doi:10.1186/1471-2253-4-8.