Endotracheal Cuff Pressure Changes During Helicopter Transport: A Systematic Review

Area of Science:

• Critical Care Medicine
• Aeromedical Transport
• Respiratory Physiology

Background:

• Endotracheal tube (ETT) cuff pressure is critical for ventilated patients.
• Previous studies suggest altitude may increase ETT intracuff pressure, but in vivo data is limited.
• Accurate cuff pressure is vital to prevent tracheal injury.

Purpose of the Study:

• To investigate if endotracheal tube intracuff pressure rises above critical tracheal perfusion pressure during helicopter transport.
• To assess the in vivo impact of helicopter transport on ETT intracuff pressures.

Main Methods:

• A systematic literature search was conducted across multiple databases (Ovid Medline, CINAHL, Embase, Scopus, Cochrane Library) up to January 2016.
• Additional studies were identified via Google Scholar and reference list examination.
• Inclusion criteria focused on prospective observational studies reporting ETT intracuff pressure in ventilated patients during helicopter emergency medical service transport.

Main Results:

• Two prospective observational studies met the inclusion criteria.
• Reported mean increases in ETT intracuff pressure ranged from 23 cm H2O to 33.9 cm H2O.
• Both studies indicated that ETT intracuff pressures frequently surpassed the critical perfusion pressure of the tracheal mucosa.

Conclusions:

• Findings suggest a trend of increased ETT intracuff pressure during helicopter transport.
• The clinical significance of transiently elevated intracuff pressures requires further investigation.
• Longitudinal studies are recommended to confirm these preliminary findings.