Accuracy of finger-tip palpated tracheostomy tube cuff pressure readings among otolaryngologists

2005 ◽  
Vol 119 (6) ◽  
pp. 461-464 ◽  
Author(s):  
Pushkas Gopalan ◽  
Simon T Browning
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Good Practice ◽  
High Standard ◽  
Tracheal Mucosa ◽  
Tube Cuff ◽  
Tracheostomy Tubes ◽  
Finger Tip ◽  
Mucosal Ischaemia ◽  
Consultant Group

The tracheal mucosa is very a delicate structure, and pressure–ischaemia problems following the use of cuffed tracheostomy tubes are well documented. Iatrogenic tracheal stenosis is one of the consequences of mucosal ischaemia and is very difficult to treat. In this study the accuracy of finger-tip tested tracheostomy tube cuff inflation pressure, as judged by consultants and non-consultants, was assessed by comparison with manometric pressure readings. The estimated pressure readings from the consultant group were more accurate than those from the non-consultant group, but a high standard deviation and very big difference between low and high readings in both these groups showed the real extent of the problem. Participants who performed 10 or more tracheostomies a year obtained more accurate results. No definite correlation was observed between the readings and the experience of the participants in otolaryngology or the size of the tube used. The authors recommend that instrumental monitoring of cuff pressure be considered good practice among junior otolaryngologists.

scholarly journals What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

2020 ◽  
Vol 44 (5) ◽  
pp. 402-408
Author(s):  
Dong Min Kim ◽  
Myung Jun Shin ◽  
Sung Dong Kim ◽  
Yong Beom Shin ◽  
Ho Eun Park ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Cadaver Study ◽  
Cuff Inflation ◽  
Cuff Volume ◽  
Tube Cuff ◽  
Different Types ◽  
Male Cadaver ◽  
Tracheostomy Tubes ◽  
Pressure Changes

Objective To determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy.Methods We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer.Results For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH<sub>2</sub>O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH<sub>2</sub>O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types.Conclusion Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

Evaluation of a teaching tool to increase the accuracy of pilot balloon palpation for measuring tracheostomy tube cuff pressure

2013 ◽  
Vol 123 (8) ◽  
pp. 1884-1888 ◽  
Author(s):  
Nancy Jiang ◽  
Anthony G. Del Signore ◽  
Alfred M. Iloreta ◽  
Benjamin D. Malkin
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Teaching Tool ◽  
Tube Cuff ◽  
Pilot Balloon

An in vitro study of tracheostomy tube cuff herniation and inflation characteristics

1996 ◽  
Vol 110 (12) ◽  
pp. 1142-1144 ◽  
Author(s):  
L. J. Hollis ◽  
J. S. Almeyda ◽  
G. Mochloulis ◽  
K. S. Patel
Keyword(s):  
Tracheostomy Tube ◽  
In Vitro Study ◽  
Vitro Study ◽  
Tube Cuff ◽  
Tracheostomy Tubes ◽  
The Uk

AbstractSeven of the most commonly used tracheostomy tubes used in the UK were tested for cuff herniation and creasing in synthetic tracheas corresponding to the shapes and sizes found in vivo. Results demonstrated that only two tubes of one particular brand herniated and that creasing occured in tubes disproportionaltely large for the trachea used. A discussion of modern tracheostomy tube manufacture is included.

Estimation of tracheostomy tube cuff pressure by pilot balloon palpation

2007 ◽  
Vol 121 (09) ◽  
Author(s):  
C Faris ◽  
E Koury ◽  
J Philpott ◽  
S Sharma ◽  
N Tolley ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Tube Cuff ◽  
Pilot Balloon

How to measure tracheostomy tube cuff pressure

2015 ◽  
Vol 30 (5) ◽  
pp. 36-38 ◽  
Author(s):  
Nicola Credland
Keyword(s):  
Tracheostomy Tube ◽  
Cuff Pressure ◽  
Tube Cuff

Understanding tracheostomy tubes

2020 ◽  
Vol 11 (3) ◽  
pp. 132-137
Author(s):  
Elizabeth Doyle
Keyword(s):  
Tracheostomy Tube ◽  
High Standard ◽  
Standard Of Care ◽  
Emergency Procedure ◽  
Veterinary Practice ◽  
Tracheostomy Tubes

It is important in veterinary practice that registered veterinary nurses (RVNs) understand why and when a tracheostomy tube may need to be placed in a patient, especially as it is often an emergency procedure. Having the knowledge on how these patients need to be nursed throughout their hospitalisation is also highly valuable and will prevent complications arising as well as enabling the RVN to deliver a high standard of care.

scholarly journals Endotracheal tube cuff pressure: An overlooked risk

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Summayah M. Fallatah ◽  
Roshdi R. Al-metwalli ◽  
Talal M. Alghamdi
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Fistula Formation ◽  
Routine Practice ◽  
Endotracheal Tube Cuff ◽  
Tracheal Mucosa ◽  
Tracheal Rupture ◽  
Factors Affecting ◽  
Tube Cuff ◽  
Endotracheal Tube Cuff Pressure

The endotracheal tube (ETT) cuff's principal function is to implement proper tracheal sealing at a pressure high enough to prevent both gas leak and fluid aspiration, and low enough to maintain tracheal perfusion. Clinicians are often concerned primarily with the volume of air required to inflate an ETT cuff. However, the most important factor is how much pressure will be exerted on the tracheal mucosa when the cuff is properly distended. Cuff over-inflation complications range from sore throat to tracheal ischemia with tracheal rupture and fistula formation. The ideal ETT cuff pressure has not been defined with a high degree of certainty however most anesthesiologists generally recommend a target pressure of 20 to 30 cmH2O. Although trachea-gas sealing can be achieved at ETT cuff pressure of 20 cmH2O, microaspiration can occur at a cuff pressure of 60 cmH2O. Since the introduction of cuffed ETT in the mid- 20th century, several modifications in the cuff's shape and material have been done to address these challenges. It has been proven that the pressure within the inflated cuff is a dynamic process. As such, various clinical factors will significantly impact the pressure reading. Thus, continuous regulation of ETT cuff pressure should be routine practice. Our review included 158 articles that addressed the background into the development of cuffed ETT, function and anatomy of the ETT cuff system, cuff pressure and sealing characteristics, ETT cuff pressure regulation, microaspiration, and factors affecting ETT cuff pressure. Key words: Endotracheal Tube; Cuff pressure; Microaspiration Citation: Al-metwalli RR, Fallatah SM, Alghamdi TM. Endotracheal tube cuff pressure: An overlooked risk. Anaesth. pain intensive care 2021;25(1):86–95; DOI: 10.35975/apic.v25i1.1445 Received: 2 November 2020, Reviewed: 24 December 2020, Accepted: 1 January 2021

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

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