Improving Endotracheal Cuff Inflation Pressures: An Evidence-Based Project in a Military Medical Center

Poor management of endotracheal tube cuff pressures occurs in more than 50% of all general anesthetics, leading to tracheal ischemia, tracheal rupture, sore throats, recurrent laryngeal nerve palsy, tracheal stenosis, microaspiration, and/or inadequate ventilation. General endotracheal anesthesia is common practice throughout the world. Endotracheal tube cuffs are filled with a fluid (gas or liquid) to a safe and adequate pressure of 20 to 30 cm H₂O to protect the lung parenchyma from aspiration while also ensuring positive pressure can be generated to oxygenate/ventilate patients. An evidence-based project to improve anesthesia providers' management of endotracheal tube cuff pressures was performed at a military medical center in the southwestern United States. The intervention consisted of an education presentation, availability of cuff manometers in all operating rooms, a charting reminder to document cuff pressures, and a visual prompt in the electronic anesthesia record. The intervention resulted in a statistically significant increase in safe cuff pressures (P = .0032; odds ratio = 4.41, 95% CI = 1.71-11.3).