Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country

Background Tracheal tubes are routinely used during anaesthesia and in the intensive care unit. Subjective monitoring of cuff pressures have been reported to produce consistently inappropriate cuffs pressures, with attendant morbidity. But this practice of unsafe care remains widespread. With the proliferation of intensive care units in Nigeria and increasing access to surgery, morbidity relating to improper tracheal cuff pressure may assume a greater toll. We aimed to evaluate current knowledge and practice of tracheal cuff pressure monitoring among anaesthesia and critical care providers in Nigeria. Methods This was a multicenter cross-sectional study conducted from March 18 to April 30, 2021. The first part (A) was conducted at 4 tertiary referral hospitals in Nigeria by means of a self-administered questionnaire on the various cadre of anaesthesia and critical care providers. The second part (B) was a nation-wide telephone survey of anaesthesia faculty fellows affiliated to 13 tertiary hospitals in Nigeria, selected by stratified random sampling. Results Only 3.1% (6/196) of the care providers admitted having ever used a tracheal cuff manometer, while 31.1% knew the recommended tracheal cuff pressure. The nationwide telephone survey of anaesthesia faculty fellows revealed that tracheal cuff manometer is neither available, nor has it ever been used in any of the 13 tertiary hospitals surveyed. The ‘Pilot balloon palpation method’ and ‘fixed volume of air from a syringe’ were the most commonly utilized method of cuff pressure estimation by the care providers, at 64.3% and 28.1% respectively in part A survey (84.6% and 15.4% respectively, in the part B survey). Conclusion The use of tracheal cuff manometer is very limited among the care providers surveyed in this study. Knowledge regarding tracheal cuff management among the providers is adjudged to be fair, despite the poor practice and unsafe care.

Intelligent Anomaly Identification of Uplift Pressure Monitoring Data and Structural Diagnosis of Concrete Dam

As an essential load of the concrete dam, the abnormal change of uplift pressure directly threatens the safety and stability of the concrete dam. Therefore, it is of great significance to accurately and efficiently excavate the hidden information of the uplift pressure monitoring data to clarify the safety state of the concrete dam. Therefore, in this paper, density-based spatial clustering of applications with noise (DBSCAN) method is used to intelligently identify the abnormal occurrence point and abnormal stable stage in the monitoring data. Then, an application method of measured uplift pressure is put forward to accurately reflect the spatial distribution and abnormal position of uplift pressure in the dam foundation. It is easy to calculate and connect with the finite element method through self-written software. Finally, the measured uplift pressure is applied to the finite element model of the concrete dam. By comparing the structural behavior of the concrete dam under the design and measured uplift pressure, the influence of abnormal uplift pressure on the safety state of the concrete dam is clarified, which can guide the project operation. Taking a 98.5 m concrete arch dam in western China as an example, the above analysis ideas and calculation methods have been verified. The abnormal identification method and uplift pressure applying method can provide ideas and tools for the structural diagnosis of a concrete dam.