2011 OPEN FORUM Abstracts
CUFF PRESSURE INCREASES OBSERVED WHEN EXTRA VOLUME IS ADDED TO AN ENDOTRACHEAL TUBE CUFF.
Jim Fielder, Roger Gilbert; Overlake Hospital Medical Center, Bellevue, WA
Background: Volume is added to endotracheal tube cuffs at the onset of intubation and at various times during the time the patient remains intubated. Frequently these additions to these volumes are made without cuff pressure measurement. The purpose of this research was to determine the effect of adding different amounts of volume to endotracheal tube cuffs. The specific aims are to determine the average amount of pressure increase to the trachea for different amounts of volume added from 0.5mL up to 3.0mL. Method: 30 endotracheal tubes from three different vendors (Mallingkrodt, Portex, Hudson RCI) were analyzed in the study. Ten tubes from each vendor were inflated to a starting pressure of 25 cmH2O inside of the artificial trachea model used. Volume was added in 0.5mL increments up to 3.0mL and the pressures documented. The process repeated for all 30 tubes. All results were documented, analyzed for their statistical measure, and charted. Results: At every level observed the pressure, increases at each 0.5mL of volume added were highest in the Mallingkrodt tube, followed by the Hudson RCI tube and the lowest pressure increases were with the Portex tube. For all three tubes, the average pressure change from each point of measure (0.5mL to 1.0mL volume added, etc.) increased in a larger increment. All 30 tubes had extremely high pressures measured when as little as 3mL of volume added to the cuff, ranging from 128 to 206cmH2O. The median pressure at 0.5mL volume added ranged from 38.00 to 45.50cmH2O, and at 3.0mL volume added ranged from 142.00 to 197.00cmH2O. Conclusions: All first cuff inflations should be performed with intention and the cuff pressure measured, not just inflating to a quick inflation with 6 to 10 ccs of volume. In addition, at any time during the intubation period, whenever it is determined the cuff volume needs to be increased, the same process be used, measurement of the cuff pressure be done at the time the volume is added. This will prevent over-inflation of the cuff, which results in high cuff pressures. We have shown a rapid increasing amount of cuff pressure for each 0.5 mL of volume added to the cuff. Our model trachea size being very similar to an adult trachea, we have shown the pressure increases rapidly with small increases in volume. Sponsored Research - None