How to Prevent Endotracheal Tube Cuff Overinflation: "5 for 25"

Adverse effects associated with elevated endotracheal (ET) tube cuff pressures above 25 cm H2O include postoperative throat pain and tissue ischemia. Anesthesia practitioners' current methods of cuff pressure estimation are often inaccurate. This quantitative, quasi-experimental quality improvement project evaluated the incidence of ET tube cuff overinflation before and after an educational intervention that recommended the use of a 5-mL over 10-mL syringe for cuff inflation. Cuff pressures were measured at 2 hospitals within a large academic health system. The mean ET tube cuff pressure before education was 46.8 cm H2O and after education was 27.1 cm H2O (P=.001). The postintervention average cuff pressure using a 10-mL syringe was 36.8 cm H2O vs 21.1 cm H2O when providers used a 5-mL syringe (P=.039). The relationship between syringe size and cuff pressure was significant (P=.001) with a positive Pearson correlation of 0.471. The ET tube cuff pressures were reduced by 42% after the intervention. Average cuff pressures when providers used a 5-mL syringe were 55% lower than with use of a 10-mL syringe. No critically high postintervention pressures were recorded when a 5-mL syringe was used. The authors recommend 5-mL syringes be used for inflation of an ET tube cuff.