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Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

Published online by Cambridge University Press:  05 April 2021

Ruo S. Chen ,
Laurel O’Connor Open the ORCID record for Laurel O’Connor [Opens in a new window] ,
Matthew R. Rebesco Open the ORCID record for Matthew R. Rebesco [Opens in a new window] ,
Kara L. LaBarge ,
Edgar J. Remotti  and
Joseph C. Tennyson
Ruo S. Chen
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
Laurel O’Connor*
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
Matthew R. Rebesco
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
Kara L. LaBarge
Affiliation:
Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New YorkUSA
Edgar J. Remotti
Affiliation:
Department of Anesthesia, Critical Care and Pain Medicine, BIDMC, Boston, MassachusettsUSA
Joseph C. Tennyson
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MassachusettsUSA
*
Correspondence: Laurel O’Connor, MD Department of Emergency Medicine University of Massachusetts Medical School 55 Lake Avenue North, WorcesterMA01655USA E-mail: laurel.o’connor@umassmemorial.org
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Abstract

Introduction:

Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O.

Objectives:

While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers.

Methods:

This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded.

Results:

In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients.

Conclusion:

An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

Keywords

airwayprehospital careresuscitation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 3 , June 2021 , pp. 283 - 286
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Pitts, R, Fisher, D, Sulemanji, D, Kratohvil, J, Jiang, Y, Kacmarek, R. Variables affecting leakage past endotracheal tube cuffs: a bench study. Intensive Care Med. 2010;36(12):2066–2073.CrossRefGoogle ScholarPubMed
Bernhard, WN, Cottrell, JE, Sivakumaran, C, Patel, K, Yost, L, Turndorf, H. Adjustment of intracuff pressure to prevent aspiration. Anesthesiology. 1979;50(4):363–366.CrossRefGoogle ScholarPubMed
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416.CrossRefGoogle Scholar
Touat, L, Fournier, C, Ramon, P, Salleron, J, Durocher, A, Nseir, S. Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome. Intensive Care Med. 2013;39(4):575–582.CrossRefGoogle ScholarPubMed
Sole, ML, Su, X, Talbert, S, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. Am J Crit Care. 2011;20(2):109–118.CrossRefGoogle ScholarPubMed
Tennyson, J, Ford-Webb, T, Weisberg, S, LeBlanc, D. Endotracheal tube cuff pressures in patients intubated prior to helicopter EMS transport. West J Emerg Med. 2016;17(6):721–725.CrossRefGoogle ScholarPubMed
Sengupta, P, Sessler, DI, Maglinger, P, et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol. 2004;4(1):8.CrossRefGoogle ScholarPubMed
Benumof, JL, Cooper, SD. Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth. 1996;8(2):136–140.CrossRefGoogle ScholarPubMed
Rubio, PA, Farrell, EM, Bautista, EM. Severe tracheal stenosis after brief endotracheal intubation. South Med J. 1979;72(12):1628–1629.CrossRefGoogle ScholarPubMed
Alvarez-Maldonado, P, Vidal, E, Cerón-Díaz, U. Tracheal ulcers due to endotracheal tube cuff pressure. J Bronchology Interv Pulmonol. 2011;18(3):288–289.CrossRefGoogle ScholarPubMed
Lim, H, Kim, JH, Kim, D, et al. Tracheal rupture after endotracheal intubation - a report of three cases. Korean J Anesthesiol. 2012;62(3):277–280.CrossRefGoogle ScholarPubMed
Hameed, AA, Mohamed, H, Al-Mansoori, M. Acquired tracheoesophageal fistula due to high intracuff pressure. Ann Thorac Med. 2008;3(1):23–25.CrossRefGoogle ScholarPubMed
Bunegin, L, Albin, MS, Smith, RB. Canine tracheal blood flow after endotracheal tube cuff inflation during normotension and hypotension. Anesth Analg. 1993;76(5):1083–1090.CrossRefGoogle ScholarPubMed
Nordin, U, Lindholm, CE, Wolgast, M. Blood flow in the rabbit tracheal mucosa under normal conditions and under the influence of tracheal intubation. Acta Anaesthesiol Scand. 1977;21(2):81–94.CrossRefGoogle ScholarPubMed
Curiel García, JA, Guerrero-Romero, F, Rodríguez-Morán, M. Presión del manguito en la intubación endotraqueal: debe medirse de manera rutinaria? [Cuff pressure in endotracheal intubation: should it be routinely measured?]. Gac Med Mex. 2001;137(2):179–182.Google Scholar
Peters, JH, Hoogerwerf, N. Prehospital endotracheal intubation; need for routine cuff pressure measurement? Emerg Med J. 2013;30(10):851–853.CrossRefGoogle ScholarPubMed
Hoffman, RJ, Parwani, V, Hahn, IH. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. Am J Emerg Med. 2006;24(2):139–143.CrossRefGoogle ScholarPubMed
Parwani, V, Hoffman, RJ, Russell, A, Bharel, C, Preblick, C, Hahn, IH. Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques. Prehosp Emerg Care. 2007;11(3):307–311.CrossRefGoogle ScholarPubMed
Galinski, M, Tréoux, V, Garrigue, B, Lapostolle, F, Borron, SW, Adnet, F. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med. 2006;47(6):545–547.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.CrossRefGoogle ScholarPubMed