Unintentional endotracheal tube cuff deflation during routine checks: a simulation study

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Patient Safety

Background:

• Endotracheal tube cuff pressure is critical for preventing aspiration of secretions.
• Maintaining cuff pressure between 20-30 cmH2O is recommended to prevent aspiration.
• Poor technique during cuff pressure monitoring can lead to serious complications like ventilator-associated pneumonia.

Purpose of the Study:

• To assess if intensive care staff unintentionally deflate endotracheal tube cuffs below 20 cmH2O during routine pressure checks.
• To evaluate the technique used with handheld manometers for endotracheal tube cuff pressure adjustments.

Main Methods:

• An exploratory simulation study was conducted with 20 critical care staff (10 medical, 10 nursing).
• Participants used a handheld manometer to adjust a mannequin's endotracheal tube cuff pressure to the target range.
• Lowest and final cuff pressures were recorded during the simulation.

Main Results:

• 59% of participants transiently deflated the endotracheal tube cuff below 20 cmH2O during pressure adjustments.
• Four participants deflated the cuff to 0 cmH2O before re-inflation.
• Most participants (88%) successfully re-inflated the cuff to the target range (20-30 cmH2O).

Conclusions:

• Unintentional endotracheal tube cuff deflation can occur during routine pressure monitoring with handheld manometers.
• This technique poses a risk for pulmonary aspiration and ventilator-associated pneumonia.
• Further research into automated, continuous cuff pressure monitoring devices is recommended.