Comparison of endotracheal cuff pressure measurements before and after nursing care in emergency patients: pilot balloon palpation (original) (raw)
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Alexandria Scientific nursing journal, 2022
Background: Endotracheal intubation and mechanical ventilation are essential lifesaving procedures for many critically ill patients. Tracheal intubation with a cuffed tube is considered definitive airway management in adults. The tube cuff is designed to provide a seal against aspiration and to prevent leaks during positive pressure ventilation. A cuff pressure between 20 and 30 cmH2O has been proposed guideline published by the Royal College of Anaesthetists to prevent the complications of over/under inflation of the cuff. Objective: To compare the endotracheal tube cuff pressure measurements before and after nursing interventions among mechanically ventilated patients. Settings: The study was carried out in the general ICU at Damanhour Medical National Institute that consist of three main halls with fifteen beds; hall I (4 beds), hall II (4 beds), and hall III (8 beds).. Subjects: A convenient sample of 70 adult patients who were mechanically-ventilated via an endotracheal tube with high-volume low-pressure cuff and a diameter ranging from 7-8.5 mm were included in the study. Tools: one tool was developed by the researcher used for data collection namely "Endotracheal tube cuff pressure measurement record". It was used to record the endotracheal tube cuff pressure measurements before and after the selected nursing interventions. It consists of three parts. Cuff pressure was assessed before nursing interventions and after nursing interventions. Results: The majority of the studied sample was male with age 51-60 years. Results of the study showed that there was a significant decrease in the mean values of endotracheal cuff pressure starting before till 30 minutes after the complete bed bath, oral hygiene, and right and left lateral positioning procedures. Conversely in the endotracheal suctioning, the mean value of ETT cuff pressure before showed an increase immediately after, followed by a decrease after 15 minutes, then an increase after 30 minutes. Conclusion: The study concluded that the cuff pressure measurements were significantly changed after performing the selected nursing interventions at different timing. Recommendations: Conducting educational program for the ICU nurses to indicate the importance of the endotracheal tube cuff pressure measurement after performing each of selected nursing interventions.
South African Medical Journal, 2013
Tracheal stenosis is a potentially life-threatening complication that occurs as a result of damage to the endotracheal mucosa. Healing by granulation and re-epithelialisation causes cicatricial stenosis. [1,2] The stenosis may present weeks to months after intubation, often as an airway emergency, and is difficult and costly to treat. The incidence of post-intubation tracheal stenosis in intensive care patients is as high as 20% in some centres. [2] Endotracheal intubation is associated with varying degrees of tracheal injury. Autopsy studies have shown that maximal damage always occurs at the site of the cuff. [1] An over-pressurised endotracheal cuff impairs mucosal blood flow, causing ischaemia. [3] The recommendation arising out of this study was that cuff inflation pressure should not exceed 30 cmH 2 O. Early pathological changes are superficial tracheitis and fibrin deposits to shallow ulcerations overlying the anterior portion of the cartilaginous rings. The size and extent of the ulcers increase with time, leading to exposure of the cartilaginous rings. Softening, splitting and fragmentation of the cartilage follow at a later stage. [1] Many studies have shown that digital balloon palpation corresponds poorly with the actual measured endotracheal cuff pressure. [4-11] Despite this evidence, endotracheal cuff pressure manometers are not readily available in the theatre complex at Groote Schuur Hospital (GSH), Cape Town, South Africa (SA), and there are no manometers available in the trauma and emergency departments. Previous studies have shown unacceptably high cuff pressures in the prehospital setting and in emergency departments. [9,12,13] Considering the high rates of trauma in SA, it is important to prevent iatrogenic complications in these patients. To our knowledge, no studies have measured endotracheal cuff pressures in trauma or emergency patients in SA. The purpose of this study was to evaluate cuff pressures in the GSH trauma centre and theatre complex and to assess whether objective monitoring of cuff pressures with manometers is warranted. Secondary outcomes were whether the tube make or size and the place of intubation affected cuff pressure. Method An audit was conducted over a 4-month period at GSH. The audit consisted of 91 intubated patients in the trauma centre and 100 intubated patients in the theatre complex. They were randomly selected and their cuff pressures were measured by a single investigator to decrease inter-user variability. A minimum sample size of 16 patients per group was calculated to achieve 91% power to detect a difference of 30.0 between the null hypothesis (that both group means are 55.0) and the alternative hypothesis (that the mean of group 2 is 25.0), with known group standard deviations of 33.0 and 15.0 and with a significance level (alpha) of 0.05000, using a two-sided Mann-Whitney test assuming that the actual distribution is uniform. We used a larger sample size because we wanted to perform subgroup analyses. All data collected were recorded on a standardised datasheet and transcribed to an electronic database for analysis. Cuff pressures were measured using a Mallinckrodt cuff pressure gauge, for which the Endotracheal tube cuff pressures-the worrying reality: A comparative audit of intra-operative versus emergency intubations
Turkiye Klinikleri Journal of Nursing, 2016
Bu çalışma hemşirelerin endotrakeal tüp (ETT)/trakeostomi tüpü(TT) kaf basıncı uygulamaları konusundaki bilgi ve uygulamalarını belirlemek amacıyla tanımlayıcı olarak yapılmıştır. Gereç ve Yöntemler: Çalışmaya yoğun bakım ünitelerinde en az 6 ay çalışan hemşireler dâhil edilmiştir. Araştırmaya katılmayı kabul eden ve araştırmanın amacına uygun olarak ETT/TT kaf basıncı uygulamalarının yapıldığı 6 adet yoğun bakım ünitesinde çalışan 120 hemşireden 80'i çalışmaya katılmayı kabul etmiştir. Çalışmanın yapıldığı kurumdan etik kurul onayı alınmıştır. Bulgular: Araştırmaya katılan hemşirelerin yaş ortalaması 29,50'dir. Hemşirelerin %80'i lisans mezunudur ve yoğun bakım ünitesinde 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 kullandığı yöntem ise (%91,30) bağlayıcı materyal kullanarak tüpü sabitlemektir. Hemşirelerin %20'si uygun şekilde her vardiyada bir defa kaf basıncını ölçtüğünü ifade ederken, %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 H 2 0 olduğunu, %28.80'i de kaf basıncını ölçmek için pozisyon vermediklerini söylemektedir. Sonuç: Araştırmada hemşirelerin ETT/TT kaf basıncı uygulamaların da bilgi gereksinimleri olduğu saptanmıştır. Kanıta dayalı ETT/TT kaf basıncı uygulama protokollerinin geliştirilmesi, hemşirelik bakımında farklı ve yanlış uygulamaları ortadan kaldırılmasına yardımcı olacaktır. Anah tar Ke li me ler: Trakeostomi; entübasyon, intratrakeal; basınç; yoğun bakım; ventilatörler, mekanik; hemşirelik ABS TRACT Objective: This study was conducted as descriptive to determine nurses' knowledge and practises about ETT/TT cuff pressure practices. Material and Methods: 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. Results: 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 fix 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 state that the right cuff pressure range is 10-20 cm H2O, 28.80% of the nurses says that they do not give position to patient to measure the cuff pressure. Conclusion: It is determined in our research that nurses need knowledge about cuff pressure applications. Developing protocols of cuff pressure practices will eliminate different and wrong practices in nursing care.
Assiut Scientific Nursing Journal
Background: Endotracheal cuff pressure monitoring is an essential part of airway management, especially in critically ill patients undergoing mechanical ventilation. The aim: was to evaluate the effect of suctioning on endotracheal cuff pressure monitoring during fixed volume versus minimal leak techniques among mechanically ventilated patients. Design: A quasi-experimental research design was used to conduct the current study using a pre post technique approach. Setting: This study was conducted at both Anesthesia and Surgical Intensive Care Units affiliated to Tanta University Hospitals, Subjects: A convenience sample of 60 adults who were newly admitted to Intensive Care Units within 48 hours and undergoing oral or nasal endotracheal tube. Tools: Two tools were utilized to collect data; (tool I) patients' bio-sociodemographic characteristics and (tool II) endotracheal cuff pressure assessment. The results: clarified that there were highly statistically significant differences regarding intra cuff pressure pre and post suctioning in both fixed volume and minimal leak techniques groups with a p-value <0.001. Conclusions: It was clarified that there was a moderate degree of positive statistical correlation regarding intra cuff pressure pre and post suctioning among patients in the fixed volume group. While there was a higher degree of positive statistical correlation regarding intracuff pressure pre and post suctioning among patients in the minimal leak group. Therefore, the minimal leak seems to be a more reliable technique to measure intracuff pressure than the fixed volume. Recommendations: it was recommended that endotracheal cuff pressure monitoring should be integrated into routine care for critically ill patients undergoing mechanical ventilation.
Journal of cardiovascular and thoracic research, 2017
Filling tracheal tube cuff (TTC) after intubation is necessary to provide a safe airway in intubated patients. On the other hand, excessive increase or decrease in the pressure of TTC's balloon leads into the dangerous complications such as necrosis and/or aspiration. Accordingly, in the present study, we tried to evaluate the most two common fixed volume and pilot balloon palpitation methods to control TTC pressure.In a prospective cross-sectional study that was carried out in the emergency department of Tabriz Imam Reza hospital upon 194 patients who needed intubation and from April 2015 to June 2016. The patients were randomly allocated into two equal groups. For the first the Pilot Balloon Palpation technique and for the second group 10 cc fixed volume cuff filling technique was assigned. After that, the pressure was checked with manometer and data were analyzed using SPSS software.TTC pressure average in fixed volume group was 44.96±21.77 cmH2O and for palpation group, it w...
Nigerian Journal of Clinical Practice, 2013
Context: Endotracheal tube cuff pressure (ETCP) is recommended to be maintained between 20-30 cmH 2 O limits. While insufficient inflation of ETC may cause aspirations, over-inflation of it may lead to damage in tracheal epithelium. Aims: We planned to investigate the effects of user experience and cuff pressure inflation method differences following endotracheal tube cuff pressure and complaints about it. Patients and Methods: Two hundred and fifty patients planned for general anaesthesia were included in this study. ETC was inflated by users with different experience according to leakage or pilot balloon palpation techniques. ETCPs were measured by manometer at three periods (5 and 60 minutes after endotracheal intubation, and before extubation). Complaints about it were recorded in post anaesthetic care unit and 24 hours postoperatively. Results: Though we found experience of user had significant effect on the ETCP regulations, we observed inflation methods did not have any effect. However we found ETCP was higher than normal range with experienced users. A correlation was observed between cuff pressure and anaesthesia duration with postoperative complaints. Conclusions: Our study concluded that the methods used do not have any significant advantage over one another. While ETC inflated at normal pressure increases as user's experience increases, experience alone is not enough in adjusting ETCP. A manometer should be used in routine inflation of ETC instead of conventional methods. CP and anaesthesia duration have correlations with some postoperative complaints.
Anesthesiology Research and Practice, 2017
Background Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20–30 cmH2O) is the cuff pressure manometer, but this is not widely available, especially in resource-limited settings where its use is limited by cost of acquisition and maintenance. Therefore, anesthesia providers commonly rely on subjective methods to estimate safe endotracheal cuff pressure. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. Methods This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results One hundred seventy-...
Endotracheal Cuff Pressures in Ventilated Patients in Intensive Care
2007
Aim: To describe the endotracheal cuff pressure (P cuff ) measurements of patients receiving ventilation via endotracheal tubes in an Intensive Care Unit (ICU). Method: Pcuff were measured daily using a cuff tonometer and the pressure then adjusted to <30 cmH 2 O in patients ventilated in the ICU, over fi fteen months. Data collected were demographics, the location where intubation occurred, and airway pressures when available (PEEP, peak, and plateau). Data was analysed using Kruskal-Wallis and Dunn's Multiple Comparison Test. Results: 1073 data sets were collected from 199 intubated ventilated adults. Of all P cuff measured 15.7% (169) exceeded 30 cmH2O. The fi rst Pcuff measurements made during ICU stay had median pressure 30 cmH 2 O (IQR 23.5-40) and 34.5% (68) exceeded 30 cmH 2 O. Median P cuff of patients admitted following intubation in the Operating Theatre (OT) were 26 cmH 2 O (IQR 20-37), those via Emergency Department (ED) were 32 cmH 2 O (IQR 28-57), and those intubated in ICU were 28 cmH 2 O (IQR 22-34.25). Pcuff of patients intubated in OT differed signifi cantly from ED patients, as did ICU patients compared to ED (p <0.005). ICU and OT patients did not differ.
Annals of Emergency Medicine, 2006
Study objective: Excessive pressure exerted on the tracheal mucosa is an avoidable factor implicated as a cause of damage after intubation of the trachea with cuffed tubes. Many patients are intubated in the out-of-hospital setting by emergency medical teams. The time spent in the out-of-hospital setting could very well be long enough for tracheal mucosal damage to occur if cuff pressure is not controlled. The objective of this study is to assess the incidence of intracuff excessive pressure in the out-of-hospital setting.