Pediatric Endotracheal Tube Cuff Pressures During Aeromedical Transport

Area of Science:

• Pediatric critical care medicine
• Aeromedical transport safety
• Respiratory care

Background:

• Cuffed endotracheal tubes (ETTs) are vital in pediatric care to minimize air leaks and prevent ventilator-associated pneumonia.
• Elevated ETT cuff pressure (ETTCP) above 30 cm H2O compromises tracheal mucosal perfusion, with complete blood flow absence above 50 cm H2O.

Purpose of the Study:

• To compare endotracheal tube cuff pressures (ETTCPs) in pediatric-sized ETTs at ground level and various altitudes during simulated aeromedical transport.
• To assess the impact of altitude on ETTCP in different pediatric ETT sizes.

Main Methods:

• Four pediatric-sized mannequin heads were intubated with cuffed ETTs (3.0-6.0 mm).
• Simulated aeromedical transport via helicopter and fixed-wing aircraft was conducted 20 times each.
• ETTCP was measured at 1000-ft intervals from ground level (400-650 ft MSL) to peak altitudes (3500-5000 ft MSL).

Main Results:

• Increased altitude significantly elevated ETTCP across all tested ETT sizes (P < 0.001).
• No statistical difference in pressure increases was observed between different ETT sizes (P = 0.28).
• ETTCP exceeded 30 cm H2O around 1500 ft MSL and 50 cm H2O around 2800 ft MSL for most ETT sizes.

Conclusions:

• Pediatric ETTCP frequently surpasses recommended safety limits at relatively low altitudes during aeromedical transport.
• The risk of elevated ETTCP is not influenced by ETT size.
• Exceeding pressure limits can reduce tracheal mucosal blood flow, potentially leading to stenosis, rupture, and other complications.