How to measure tracheostomy tube cuff pressure

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.

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

The Journal of Laryngology & Otology ◽

10.1258/0022215054273070 ◽

2005 ◽

Vol 119 (6) ◽

pp. 461-464 ◽

Cited By ~ 5

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.

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Evaluation of the accuracy of finger-tip palpation of pilot balloon as a method to judge endo tracheal tube cuff pressure

MedPulse International Journal of Anesthesology ◽

10.26611/101510218 ◽

2019 ◽

Vol 10 (2) ◽

pp. 157-159

Author(s):

Manohar Mane ◽

◽

Prashant Lomate ◽

J Paranjape ◽

◽

...

Keyword(s):

Tracheal Tube ◽

Cuff Pressure ◽

Tube Cuff ◽

Tracheal Tube Cuff ◽

Pilot Balloon ◽

Finger Tip

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An insight to irrigation fluid and increased intraoperative endotracheal tube cuff pressure

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2021.05.010 ◽

2021 ◽

Author(s):

Mahesh S. Kurwe ◽

Habib Md Reazaul Karim ◽

Pradipta Bhakta

Keyword(s):

Endotracheal Tube ◽

Cuff Pressure ◽

Endotracheal Tube Cuff ◽

Tube Cuff ◽

Irrigation Fluid ◽

Endotracheal Tube Cuff Pressure

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

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000297 ◽

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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