Implementation of a Volume-Based Technique for Endotracheal Tube Cuff Inflation: A Quality Improvement Project

Background: The goal of endotracheal tube (ETT) cuff inflation is to produce a pressure within the range of 20-30 cm H₂O to ensure a proper seal against the trachea without compromising mucosal perfusion. The gold standard for the assessment of ETT cuff pressure is a handheld manometer; however, due to a lack of availability, this is rarely performed. Using a 10-mL syringe for cuff inflation is a common practice but can lead to overinflation and higher-than-recommended pressures. Objective: The purpose of this quality improvement project was to evaluate the incidence of ETT cuff overinflation and determine if an educational intervention advocating for lower volumes would reduce the occurrence. Method: The authors evaluated 50 ETT cuff pressures before and 50 after an educational intervention proposing the use of a 5-mL syringe for cuff inflation rather than a 10-mL syringe. Results: Median cuff pressure significantly decreased from 60 cm H₂O in the preintervention phase to 30 cm H₂O in the postintervention phase using 5-mL syringes, a 50% decrease (p < .001). Conclusion: This project demonstrated that an educational presentation recommending a 5-mL syringe for ETT cuff inflation resulted in a significant reduction of cuff pressures. Implications for Nursing: Nurse anesthetists should be aware of the risk of overinflation of endotracheal tube cuffs. Implementing a volume-based inflation method into current practice will decrease this incidence and the harmful sequelae associated with high cuff pressure.