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Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation
Richard W Wettstein1, Donna D Gardner2, Sadie Wiatrek1
1Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
Insights
Pediatric endotracheal tube cuff underinflation is common in the PICU. Maintaining appropriate cuff pressure is essential for intubated children, requiring improved strategies and training.
Area of Science:
- Pediatric Intensive Care
- Respiratory Therapy
- Critical Care Medicine
Background:
- Cuffed endotracheal tubes (ETTs) are increasingly used in pediatric intensive care units (PICUs).
- Adherence to safe usage guidelines is crucial to mitigate risks associated with cuffed ETTs.
- Traditional use of uncuffed ETTs is being re-evaluated against evidence supporting cuffed ETT safety.
Purpose of the Study:
- To measure endotracheal tube cuff pressure (CP) in intubated pediatric subjects.
- To determine the incidence of cuff underinflation (<20 cm H2O) and overinflation (>30 cm H2O).
- To explore associations between CP and patient/device factors like age, gender, ETT size, and length of stay.
Main Methods:
- Prospective observational study in an urban PICU.
- Daily measurement of ETT cuff pressures in pediatric patients intubated with cuffed ETTs.
- Statistical analysis including t-tests and Pearson chi tests to compare CP with demographic and clinical variables.
Main Results:
- Eleven of twenty subjects had normal cuff pressures; nine had underinflated cuffs.
- No instances of overinflation were detected.
- No significant associations were found between cuff pressure and ETT size, duration of intubation, gender, or age.
Conclusions:
- Endotracheal tube cuff underinflation is a frequent issue in the PICU.
- Implementing strategies to maintain adequate cuff pressures is vital for intubated pediatric patients.
- Further research is needed to develop interventions and training for consistent cuff pressure measurement using manometers.
Background:
While uncuffed endotracheal tubes have been traditionally used in the pediatric intensive care unit (PICU) population, evidence suggests cuffed endotracheal tubes (ETTs) are also safe to use within this population. Nevertheless, risks related to the use of cuffed ETTs increase when guidelines for safe and appropriate use are not followed. The primary goal of this study was to measure the cuff pressure (CP) using a cuff pressure manometer in a group of intubated pediatric subjects and determine the rate of cuff underinflation (<20 cm H20) or overinflation (>30 cm H20). The secondary aim was to determine whether CP was associated to gender, age, ETT size, and PICU length of stay prior to CP measurement.
Methods:
This was a prospective observational study conducted in an urban PICU. Pediatric subjects intubated with cuffed ETTs from 1 April 2017 to 1 May 2017 were included in the study. ETT CPs were measured daily to determine degree of inflation and compared according to gender, age, ETT size, and number of days intubated prior to CP measurement. Descriptive data are expressed as means and standard deviations. A two-sample t test was used to compare groups according to age, gender, and number of days present. And significance was considered with a P < 0.05. Pearson chi test was used to evaluate correlation between CPs and size of the ETT, number of days intubated prior to CP measurement, gender, and age.
Results:
Twenty pediatric subjects admitted during the study period were included for analysis. Eleven cuff measurements were found to be within normal limits, while 9 cuff measurements were found to be underinflated. No cases of overinflation were found. There were no significant associations between CP and size of the ETT (r = -0.08), number of days intubated prior to CP measurement (r = 0.19), gender (r = 0.09), and age (r = 0.12).
Conclusions:
Our study suggests that endotracheal cuff underinflation occurs often in the PICU population. Strategies to ensure appropriate ETT CPs are maintained are essential in the intubated pediatric population. Additional studies are necessary to develop interventions and training focused on the use of a cuff pressure manometer to measure CPs in the PICU by respiratory therapists and ensure consistent measurement using inter rater evaluation processes are needed.
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