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Endotracheal tube cuff pressures in pediatric patients intubated before aeromedical transport
William W Tollefsen1, Jacob Chapman, Michael Frakes
1Harvard Affiliated Emergency Medicine, Brigham and Women's Hospital/Massachusetts General Hospital, 75 Francis St, Neville House-236A, Boston, MA 02115, USA. wtollefsen@partners.org
Insights
High endotracheal tube cuff pressures (ETTCPs) are common in pediatric patients during critical care transport. This study found no clear risk factors, emphasizing the need for routine ETTCP monitoring.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Emergency Medicine
Background:
- Elevated endotracheal tube cuff pressures (ETTCPs) exceeding 30 cm H2O pose a risk of complications in intubated patients.
- Cuffed endotracheal tubes (ETTs) are increasingly used in pediatric patients, raising concerns about overinflation and associated risks.
Purpose of the Study:
- To determine the incidence of elevated ETTCP in pediatric patients undergoing critical care transport.
- To identify potential associations between high ETTCP and patient demographics, diagnostic category, or intubator qualifications.
Main Methods:
- Prospective study assessing ETTCP in pediatric patients intubated with cuffed ETTs prior to critical care transport.
- Cuff pressures were measured upon arrival of the transport team using a standardized manometry device.
- Elevated pressures (>30 cm H2O) were immediately corrected.
Main Results:
- A significant proportion (41%) of pediatric patients exhibited elevated ETTCP (>30 cm H2O).
- Notably, 30% of these elevated pressures were critically high, exceeding 60 cm H2O.
- No statistically significant associations were found between elevated ETTCP and patient demographics, intubator credentials, or intubation location.
Conclusions:
- Elevated ETTCP is a prevalent issue in pediatric patients during critical care transport.
- The study identified no specific risk factors for high cuff pressures, underscoring the need for universal ETTCP monitoring.
- Further research is recommended to explore educational interventions and the clinical impact of elevated ETTCPs.
Objectives:
Prolonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H2O can cause complications. With increasing utilization of cuffed endotracheal tubes (ETTs) in pediatric patients comes the risk of overinflation. We evaluated the incidence of elevated ETTCP in pediatric patients intubated with cuffed ETTs, transported by a critical-care transport service and attempted to identify whether elevated ETTCP was associated with factors such as patient demographics, diagnostic category, and intubator credentials.
Methods:
In this prospective study, assessment of ETTCP was made upon transport crew arrival at the bedside. The study focused on a consecutive sample of pediatric patients undergoing transport with cuffed ETTs placed before transport team arrival. All patients had cuff pressures assessed by the same cuff manometry device. Pressures found to be greater than 30 cm H2O were corrected immediately.
Results:
Forty-one percent of cases met the a priori defined cutoff for elevated ETTCP of 30 cm H2O; 30% of those elevated cuff pressures were twice that cutoff (>60 cm H2O). There were no associations between high ETTCP and any of the following independent variables: demographics, physician versus nonphysician intubator, and intubation location (ie, scene vs emergency department vs intensive care unit).
Conclusions:
A significant number of pediatric patients transported by a critical-care transport service had elevated ETTCP. Furthermore, there was no clear risk factor for elevated cuff pressures. This is further evidence that cuff pressures should be measured in all patients. Further research should focus on the effect of educational intervention and on the possible clinical results of elevated ETTCPs.
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