The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

POST-OP MONITORING OF ENDOTRACHEAL/TRACHEOSTOMY TUBES BLINDLY INFLATED IN THE OPERATING ROOM (OR)

Mary E. Nash1, Susan LaGambina1, Paul F. Nuccio1, Gerald L. Weinhouse2; 1Department of Respiratory Care, Brigham and Women’s Hospital, Boston, MA; 2Pulmonary & Critical Care Division, Brigham and Women’s Hospital, Boston, MA

Background: Studies have shown that endotracheal tube cuff over-inflation exerts pressure on the tracheal wall decreasing capillary perfusion to the tracheal mucosa. Complications of excessive cuff pressures include tissue necrosis, tracheal stenosis, post intubation stridor, along with rupture and tracheal esophageal fistula. Safe cuff pressures have been determined to be 25-30cm H2O pressure. Under-inflation increases the risk of aspiration. The purpose of this study was to determine the initial cuff pressures of intubated patients admitted from the OR. Method: Post-operative cuff pressures were measured in a blind study over a period of one hundred and fifteen days. One hundred and eight patients were intubated with a high volume low pressure cuffed oral endotracheal tube, seven patients with tracheostomy tubes. The measurements were taken with a manual cuff pressure manometer and recorded by the Respiratory Therapist on patient’s arrival from the OR. Other factors were also included: Male or Female, intubation time and OR service. Results: Thirty-four patients had cuff pressures greater than 60cm H2O (30%),thirty-five patients had cuff pressures greater than 30 cm H20 (30%),fifteen patients (13%) had cuff pressures less than 25 cm H2O and the remaining thirty-one patients (27%) had cuff pressures within normal limits. 73% of patients were male and 27% were female. Average time patient was intubated before cuff pressures were assessed were Cardiac 387 minutes, Surgical 525 minutes, Trauma 440 minutes, Neuro 150 minutes and Medical 300 minutes. Conclusion: Reviewing cuff pressures on patients admitted from the OR showed an overall increase in cuff pressures. The risk of injury resulting from over-inflation of ETT cuffs can be minimized with evaluation of cuff pressure measurements. Review and education must be enhanced and implemented to enable improvement by having patients cuff pressures assessed immediately upon admission, and notifying appropriate teams when cuff pressures are above acceptable levels on the average patient. Sponsored Research - None

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