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Endotracheal Tube Cuff Pressures in the Operating Room of a Pediatric Hospital: A Quality Improvement Initiative

Kelly M Moon1,2, Sherry Donaworth1, Molly S Hagele2

  • 1College of Nursing, University of Cincinnati, Cincinnati, Ohio.

Pediatric Quality & Safety
|December 15, 2022
PubMed

Insights

Maintaining endotracheal tube (ETT) cuff pressures within the 20-30 cm H2O range is crucial for patient safety. A quality improvement project found that the removal of air technique effectively increased the percentage of ETT cuff pressures within the recommended range.

Area of Science:

  • Anesthesiology
  • Quality Improvement
  • Patient Safety

Background:

  • Endotracheal tube (ETT) cuff pressures outside the 20-30 cm H2O range can cause serious complications, including tracheal stenosis and aspiration.
  • Current methods for inflating ETT cuffs lack consistency among anesthesia providers, leading to frequent deviations from recommended pressures.

Purpose of the Study:

  • To improve the accuracy of endotracheal tube (ETT) cuff pressures, aiming to increase the percentage of pressures within the recommended 20-30 cm H2O range.

Main Methods:

  • A quality improvement project utilizing four plan-do-study-act (PDSA) cycles was conducted over nine months.
  • Control charts were employed to monitor and evaluate the primary outcome measure of ETT cuff pressure accuracy.

Main Results:

  • Prior to the intervention, ETT cuff pressures were outside the recommended range 76% of the time.
  • The 'removal of air' technique demonstrated the highest effectiveness, achieving cuff pressures within the recommended range 50% of the time (P < 0.001), significantly outperforming other tested methods.

Conclusions:

  • The 'removal of air' technique, a simple and practical method, significantly increased the percentage of endotracheal tube (ETT) cuff pressures within the recommended range.
  • Implementing this technique can enhance the safety of anesthetic management, particularly in pediatric patients.

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