Optimizing patient safety: Unveiling the significance of cuff pressure in anaesthesia

• Published in: Trends in anaesthesia & critical care 2024-10, Vol.58, p.101493, Article 101493
• Main Authors: Valentim, Maria, Barbosa, João, Almeida, Mariana, Alves, Sara, Salgado, Helena
• Format: Article
• Language: English
• Subjects: Cuff pressure; Endotracheal intubation; Safety
• ISSN: 2210-8440
• DOI: 10.1016/j.tacc.2024.101493

Inadequate pressure in the endotracheal tube (ETT) cuff can lead to compromised ventilation or airway injury. Accurate assessment of ETT cuff pressure is essential and should be performed using a manometer, with an optimal target range of 20–30 cmH2O. In this study, we aimed to audit ETT cuff pressures in the operating theatre of our institution, utilizing a manometer from VBM Medizintechnik GmbH™. Following approval from the ethics committee, we conducted an audit from January 2023 to November 2023. A convenience sample was utilized, including adult patients who were intubated in our operating rooms (ORs) during either the morning or afternoon shifts at the time of the audit. A total of 49 patients were evaluated. Our findings revealed that 78 % of the patients had cuff pressures outside the recommended target range, with recorded pressures ranging from 18 cmH2O to 120 cmH2O, and a mean pressure of 63 cmH2O. Nitrous oxide was not used in any of the cases. Cuff inflation was performed using different syringe volumes: a 5 mL syringe was used in one case, a 10 mL syringe in 20 cases, and a 20 mL syringe in 28 cases, with a mean inflation volume of 9 mL. Statistical analysis indicated no significant difference in ETT cuff pressure related to the type of syringe used or the size of the endotracheal tube. Additionally, no correlation was found between the volume of air used for cuff inflation and the resulting ETT cuff pressure. Our audit revealed that only 22 % of the patients had cuff pressures within the recommended limits, highlighting a significant need for increased awareness and education. As maintaining appropriate cuff pressure is a standard of care, systematic implementation of reliable cuff pressure monitoring is strongly recommended. •ETT's cuff pressure is frequently out of correct range.•Over or underinflated cuff may predispose patients to complications.•Finger sensibility, standard volume or syringe type do not prevent error.•It is important to adopt reliable cuff pressure monitor as a standard of care.