Management of endotracheal tube cuff pressures in the intensive care unit at a tertiary hospital: a review of the adequacy of current practices

Abstract

Background: The inappropriate management of endotracheal tube (ETT) cuff pressures in ventilated patients in the intensive care unit (ICU) is associated with myriad complications and increased morbidity and mortality.^1,2 International recommendations agree that ETT cuff pressure should be maintained in the 20–30 cmH₂O range to minimise potential harm to intubated patients.^3-8 Currently, the ICU at Dr George Mukhari Academic Hospital (DGMAH) has no formal protocol for ETT cuff pressure management, potentially exposing patients to risk and the hospital to increased healthcare costs and burdens. This study investigated whether ETT cuff pressure management practices in the ICU at DGMAH aligned with the recommended standard and allowed pressures to remain within the 20–30 cmH₂O range.

Methods: Over three months, 205 patients, within 24 hours of admission to the ICU, were recruited in a prospective, observational cross-sectional survey. The initial ETT cuff pressure was measured. If the pressure was outside the 20–30 cmH₂O range, the volume of adjustment needed to bring the measurement into range was documented. The minimal pressure at which a leak was occluded clinically by auscultation was recorded.

Results: In our study, 25% of patients (95% confidence interval [CI] 19.9% to 31.7%) surveyed had ETT cuff pressures within the recommended range, with 65% (95% CI 57.6% to 70.6%) falling over the upper threshold, and 21% (95% CI 6.8% to 15.2%) being underinflated according to the recommendations. Of the 205 participants, 153 (74.6%) required adjustment of their ETT cuff pressure at the time of data collection, with 121 (59%) achieving a clinical seal below the reference range.

Conclusion: We concluded that the current practice of measuring the ETT cuff pressure at the discretion of the treating clinician without a standardised protocol results in a significant percentage of patients with inappropriate cuff pressures going undetected.