Endotracheal tube cuff pressures in patients intubated before transport

Chapman, James; Pallin, Daniel J.; Ferrara, L E; Mortell, Sarah; Pliakas, John; Shear, Melissa L.; Thomas, Stephen

doi:10.1016/j.ajem.2008.07.025

Cited by 25 publications

(16 citation statements)

References 7 publications

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“…9 Yüksek kaf basıncının etkilerinin kaç dakikada ortaya çıktığı ile ilgili yeterli kanıt olmasa da yapı-lan hayvan deneylerinde ETT/TT kaf basıncının 15 dakika boyunca yüksek kalmasının mukozal hasara yol açtığı saptanmıştır. 13 Ayrıca yoğun bakım hastalarıyla yapılan çalışmalarda, ETT/TT kaf basıncının bu hastaların çoğunda (%62) yük-sek olduğu saptanmıştır. 10,14 Özellikle anestezi esnasında azot gazı kullanılıyorsa,bu gaz ETT/TT kafı içerisine difüze olabildiği için basıncın yük-selmesine yolaçmaktadır.…”

Section: öLçüm Sikliğiunclassified

Investigation of the Nurses Tracheostomy/Endotracheal Tube Cuff Pressure Practices in Intensive Care Units

Tekin¹,

İyigün²

2016

Turkiye Klinikleri J Nurs

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Ö ÖZ ZE ET T A Am ma aç ç: Bu çalışma, hemşirelerin endotrakeal tüp (ETT)/trakeostomi tüpü (TT) kaf basıncı uygulamaları konusundaki bilgi ve uygulamalarını belirlemek amacıyla tanımlayıcı olarak yapılmıştır. G Ge er re eç ç--Y Yö ön nt te em m: Çalışmaya yoğun bakım ünitelerinde en az altı ay çalışan hemşireler dahil edilmiştir. Araştırmaya katılmayı kabul eden ve araştırmanın amacına uygun olarak ETT/TT kaf basıncı uygulamalarının yapıldığı altı farklı yoğun bakım ünitesinde çalışan 120 hemşireden 80'i çalışmaya katılmayı kabul etmiştir. Çalışmanın yapıldığı kurumdan etik kurul onayı alınmıştır.B Bu ul lg gu ul la ar r: Araştırmaya katı-lan hemşirelerin yaş ortalaması 29,50'dir. Hemşirelerin %80'i lisans mezunudur ve yoğun bakım üni-tesinde çalışma süreleri ortalama 5 yıldır. Çalışmamızda hemşirelerin neredeyse tamamı kafın fonksiyonunun ETT/TT'nin sabitlenmesine yardımcı olduğunu ifade etmektedir. Tüpün sabitlenmesi için hemşirelerin en sık (%91,30) kullandığı yöntem ise bağlayıcı materyal kullanarak tüpü sabitlemektir. Hemşirelerin %20'si uygun şekilde her vardiyada bir kez kaf basıncını ölçtüğünü ifade ederken yarısından fazlası %52'si mekanik ventilatör alarm verdiğinde ölçtüğünü belirtmektedir. Hemşirelerin %32'si manometre ile ölçtüğünü söylemektedir. Hemşirelerin %68,80'i ise test balonunu manuel olarak kontrol ettiklerini ifade etmektedir. Hemşirelerin %42,50'si doğru kaf basınç aralığının 10-20 cm H20 olduğunu, %28,80'i de kaf basıncını ölçmek için pozisyon vermediklerini söylemektedir. S So on nu uç ç: : Araştırmada, hemşirelerin ETT/TT kaf basıncı uygulamaları konusunda bilgi gereksinimleri olduğu saptanmıştır. Kanıta dayalı ETT/TT kaf basıncı uygulama protokollerinin geliştirilmesi, hemşirelik bakımında farklı ve yanlış uygulamaları ortadan kaldırılmasına yardımcı olacaktır. Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Nurses that agreed to participate and at least 6 months working in intensive care unit were included in the research. Eighty of 120 nurses woerking in 6 intensive care units that running ETT/TT cuff pressure practices fort he purposes of the study are agreed to participate in the research. The study was approves by the ethics commitee of the institution. R Re es su ul lt ts s: : The average age of nurses that participate in research is 29.50. Eighty percent of them have bachelor degree and their average period of working in intensive care unit is 5 years. Almost all of the nurses say that cuff function helps to fixinğ the ETT/TT tube. The most common method that nurses use for fixing the tube (91.30%) is using the wrapping material to fix the tube. When 20 % of nurses state that they measure cuff pressure once in every shift appropriately, 52% of them state that they measure cuff pressure after mechanical ventilator alarms. Although it is the most accurate measurement of cuff pressure is with manometer, only 32% of nurses state they measure with this method. Sixty eight percent of nurses state that they check the test balloon by hand. Fourty two percent of the nurses sta...

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Section: öLçüm Sikliğiunclassified

Investigation of the Nurses Tracheostomy/Endotracheal Tube Cuff Pressure Practices in Intensive Care Units

Tekin¹,

İyigün²

2016

Turkiye Klinikleri J Nurs

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“…3 SAMJ ETT cuff pressures assessed by pilot balloon palpation are in fact normal, because over-inflation of ETT cuffs appears to be common in other studies. [6][7][8] Inflation of ETT cuffs to a safe pressure in the emergency care setting is important. Although usually considered to be a short period of care, the emergency phase is well within the 15-minute cut-off for initiation of tracheal injury with over-inflated ETT cuffs.…”

Section: Discussionmentioning

confidence: 99%

Assessment of safe endotracheal tube cuff pressures in emergency care - time for change?

Stein

Berkowitz²,

Kramer³

2011

S Afr Med J

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To the Editor: Endotracheal intubation is performed in the prehospital and emergency department (ED) environments by advanced life support (ALS) paramedics and emergency doctors. Cuffed endotracheal tubes (ETTs) are used in adults and more recently in children 1 to ensure that the airway is protected, and to prevent air leakage between the wall of the trachea and the ETT during positivepressure ventilation. Cuffs are typically high volume, low pressure in their design and have a safe working pressure of <30 cm H 2 O in adults 2 and <20 cm H 2 O in children.1 Over-inflation of ETT cuffs to pressures exceeding 30 cm H 2 O may result in serious complications including tracheal stenosis, tracheal rupture and tracheo-oesophageal fistula.3 Tracheal injury may occur after as little as 15 minutes with ETT cuff pressures exceeding 27 cm H 2 O.2 To avoid tracheal injury due to emergency intubation, it is important that ETT cuff over-inflation is avoided in the pre-hospital and ED phases of emergency care.Although ETT cuff pressure manometry is optimal in determining safe ETT cuff pressure, it is standard practice in the ED and in the pre-hospital emergency care environment to assess ETT cuff pressure using palpation of the cuff 's pilot balloon -a qualitative technique prone to subjective interpretation. AimsThe aims of the study were to describe the ability of a convenience sample of practising ALS paramedics and emergency doctors in Johannesburg to accurately estimate safe ETT cuff pressures using palpation of the cuff 's pilot balloon alone, and to determine whether there was any dependence between correctness of ETT cuff estimation and the practitioner's years of clinical experience and estimated monthly number of intubations. MethodsEach one of seven 7.5 mm internal diameter ETTs (Microcuff ETT, Kimberley-Clarke, Zaventem, Belgium) was placed in a single 20 ml syringe barrel to simulate a trachea. Each syringe barrel was covered with an opaque material to prevent the participant seeing the cuff inside the syringe. The ETT cuffs were inflated to seven different pressures (0, 10, 20, 40, 60, 80 and 100 cm H 2 O), using an electronic ETT cuff manometer (TRACOE Cuff Pressure Control, TRACOE Medical GmbH, Frankfurt, Germany).A convenience sample of ALS paramedics and emergency doctors was selected from various private and metropolitan emergency medical services in the Greater Johannesburg region, the Department of Surgery at the University of the Witwatersrand, and the Master of Science in Medicine (Emergency Medicine) student body at the University of the Witwatersrand. Each consenting participant was asked to complete a short questionnaire documenting their qualifications, years of clinical experience and estimated number of intubations per month. Participants were then presented with the seven described ETTs, in random order. After palpating each of the seven ETT pilot balloons, each participant verbally indicated one of three options: (i) pressure too low; (ii) safe pressure; or (iii) pressure too high. Results were ...

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“…It's been reported that hyperinflation of the cuff causes mucosal damage, destroying cilia and even ulcerating or perforating the trachea, whereas underinflating the cuff increases aspiration risk [4]. Moreover, prolonged pressures over 30 cmH2O can cause serious complications as tracheoesophageal fistula [2].…”

Section: Introductionmentioning

confidence: 99%

“…Generally, this tubes are positioned using a laryngoscope and are equipped with an endotracheal cuff. These endotracheal tube cuffs are used for 2 main reasons: they decrease the possibility of aspiration and they help to prevent air leakages during ventilation [2] .…”

Section: Introductionmentioning

confidence: 99%

Pressure Monitor in Endotracheal Cuff for Effective Intubation of Patients

Arango

Mejía-Mejía

Gómez

et al. 2017

VII Latin American Congress on Biomedical Engineering CLAIB 2016, Bucaramanga, Santander, Colombia, October 26th -28th, 2016

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Abstract-Mechanical ventilation is usually used in patients found in the intensive care units in order to avoid the appearance of respiratory acidosis, rise the oxygenation levels and reduce the workload of breathing. Endotracheal tubes have a special cuff located in the tracheal area which is used to assure an efficient ventilation of the patient. These cuffs are generally inflated without measuring its pressure, which could cause several damages to tracheal tissue or under-oxygenation. An instrument for the measurement of the endotracheal cuff pressure is proposed in this study for its use in clinical environments. It consists on an analog and digital system which measures the pressure inside the cuff and displays it on an LCD. It is portable, easy to use, non-invasive, has suitable resolution, and in a future iteration will feature a wireless communication module for its use in intensive care units. Its mean appeal is the possibility of deploying it as a cheap, high-resolution and self-calibrating monitoring device for the measurement of the pressure on the endotracheal cuff, reducing the occurrence of complications that may arise from high pressure in the cuff.

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Endotracheal tube cuff pressures in patients intubated before transport

Cited by 25 publications

References 7 publications

Investigation of the Nurses Tracheostomy/Endotracheal Tube Cuff Pressure Practices in Intensive Care Units

Investigation of the Nurses Tracheostomy/Endotracheal Tube Cuff Pressure Practices in Intensive Care Units

Assessment of safe endotracheal tube cuff pressures in emergency care - time for change?

Pressure Monitor in Endotracheal Cuff for Effective Intubation of Patients

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