A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement

Cuffed endotracheal tubes are one aspect of airway management designed to ensure safety, yet patients can be at risk for injury from underinflated and overinflated endotracheal cuffs. Tracheal pressures exceeding approximately 48 cm H2O impede capillary blood flow, potentially causing tracheal damage, and pressures below approximately 18 mm Hg may increase the risk of aspiration. There is no standard identified in the literature describing the method of cuff inflation, and nurse anesthetists use various cuff inflation techniques. The purpose of this study was to compare endotracheal cuff pressures obtained by estimation techniques with direct endotracheal cuff pressure measurements. A convenience sample of 40 anesthesia providers (nurse anesthesia students, Certified Registered Nurse Anesthetists, and anesthesiologists) inflated the endotracheal tube cuff using their usual inflation technique. The endotracheal tube cuff pressure was measured with a noninvasive manometer connected to the pilot balloon. Pressures obtained by estimation techniques ranged from 6 to 60 cm H2O (mean = 44.5; SD = 13.07). Analysis revealed that fewer than one third of the anesthesia providers inflated the cuff within an ideal range. No differences were found between level of anesthesia provider and cuff inflation pressures. We conclude that estimation techniques for cuff inflation are inadequate and suggest that direct measurements be used.