Endotracheal tube cuff pressure assessment: expectations versus reality

Damage to the trachea, although rare, is a serious complication in anesthesiology and intensive care. The main mechanism of such injury is a direct mechanical action associated with excessive pressure in the cuff of the endotracheal tube (ETT). The aim of the study was to evaluate the actual pressure in the cuffs during surgical interventions, correlate this measure with the subjective assessment of the anesthesiologist, and compare different methods of inflating the ETT cuff.

Ninety patients were randomly divided into two equal groups. In the study group, the "minimum leakage" technique was used to inflate the cuff. In the control group, the adequacy of pressure was determined by palpation of the cuff balloon. In both groups, the actual pressure was then measured using a mechanical manometer connected to the cuff.

The average ETT cuff pressure was 30.4 ± 4.9 cmH 2 O (2.98 ± 0.48 kPa) in the study group and 68.9 ± 23.3 cmH 2 O (6.75 ± 2.28 kPa) in the control group. The pressure in the ETT cuffs was within the standard safe range (i.e. 20-30 cmH 2 O) in 2/45 (4.4%) and 23/45 (51.1%) patients in the control and the study group, respectively.

In the majority of cases, the pressure achieved via evaluation by the me-thod of palpation of the control cuff was not adequate. Among various non-mechanical methods of measuring and controlling pressure in the cuff of the intubation tube, the minimum occlusion volume technique deserves attention.