Endotracheal tube cuff pressure – how fast paramedics can learn the optimal inflation? - comparison of different methods

Abstract

Background Tracheal intubation is the optimal method for opening up the airways. Performed correctly, it prevents stomach contents from entering the respiratory tract, and allows asynchronous CPR to be conducted during sudden cardiac arrest. An important element of correct intubation is proper inflation of the endotracheal tube cuff. Research has shown that when medical personnel use the palpation technique, the cuff is usually inflated incorrectly. This can result in numerous health complications for the patient. Methods This research was conducted in 2020 on a group of paramedics participating in the 15th International Winter Championship of Medical Rescuers in Bielsko-Biała. The aim of the research was to assess two methods of inflating the endotracheal tube cuff. Method A involved inflating the cuff using a syringe and assessing the pressure in the control cuff using the palpation technique. Method B involved inflating the cuff using a manometer. During the inflation, both the cuff inflation pressure and the time required to complete the procedure were recorded. Analysis was also conducted on whether completion of certified ALS and ACLS training had any influence on the effectiveness of the inflation procedure. Results The research showed that paramedics using method B significantly more often inflated the endotracheal tube cuff to the correct pressure than those using method A. However, when method B was used, the procedure took longer to conduct. The study also showed that completion of certified ALS or ACLS training did not have a significant influence on proper inflation of the cuff. Those who had completed certified training courses took significantly longer to inflate the endotracheal tube cuff when using method A. Conclusions Inflation of the endotracheal tube cuff by use of a syringe, followed by the palpation technique for assessing the inflation of the cuff balloon is ineffective. Paramedic teams should be equipped with manometers to be used for inflating the endotracheal tube cuff.