Endotracheal intracuff pressures in the ED and prehospital setting: is there a problem?

Cuffed endotracheal tubes are used to prevent gas leak and also pulmonary aspiration in ventilated patients. The pressure exerted on the tracheal wall is similar to intracuff pressure. The perfusion pressure for the tracheal mucosa is 40 cm H(2)O. Cuff pressures greater than 40 cm H(2)O may cause various ischemic changes and complications. High cuff pressures have also been implicated in postoperative sore throat and nonischemic complications. Postintubation endotracheal tube cuff pressures are not routinely measured in the ED or prehospital setting. The time spent in these settings may be long enough for pressure-induced tracheal mucosal injury to occur. The purpose of this study is to assess cuff pressures in intubated patients before aeromedical transport.

All intubated patients transported by an aeromedical transport program during a 3-month period were included in this study. Patients were intubated either by helicopter physicians or before helicopter arrival at the referring hospital or by ambulance personnel. Cuff pressure was measured using a manometer (Cuffpressure, Posey Co, USA). This measurement was recorded, and correction was performed, if necessary, to achieve a cuff pressure of 14 to 27 cm H(2)O while preventing an air leak. Data were analyzed for the distribution of intracuff pressures and incidence of elevated pressure on first measurement and the need for correction.

There were 62 patients in this study. The mean first recorded pressure was 63 +/- 34 cm H(2)O. Initial cuff pressures were greater than 40 cm H(2)O in 36 (58%) patients and required correction.

In this study, most cuff pressures exceeded safe pressure and required correction. Measurement of intracuff pressure is a simple and inexpensive procedure and should be done whenever a patient is intubated, in either the prehospital or hospital setting, because this may reduce long-term morbidity.