Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?

BACKGROUND: Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised,...

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Autores principales: Harm, Falko, Zuercher, Mathias, Bassi, Marco, Ummenhofer, Wolfgang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235018/
https://www.ncbi.nlm.nih.gov/pubmed/24304522
http://dx.doi.org/10.1186/1757-7241-21-83
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author Harm, Falko
Zuercher, Mathias
Bassi, Marco
Ummenhofer, Wolfgang
author_facet Harm, Falko
Zuercher, Mathias
Bassi, Marco
Ummenhofer, Wolfgang
author_sort Harm, Falko
collection PubMed
description BACKGROUND: Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers’ professional background. METHODS: Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an emergency department to a higher facility. RESULTS: This study included 101 patients scheduled for aeromedical transport. Median cuff pressure measured at handover was 45 (25.0/80.0) cmH(2)O; range, 8-120 cmH(2)O. There was no difference between patient characteristics and tracheal tube-size or whether anaesthesia personnel or non-anaesthesia personnel inflated the cuff (30 (24.8/70.0) cmH(2)O vs. 50 (28.0/90.0) cmH(2)O); p = 0.113. With regard to mission type (63 patients underwent an emergency transfer, 38 patients an ICU transport), median cuff pressure was different: 58 (30.0/100.0) cmH(2)O in emergency transfers vs. 30 (20.0/45.8) cmH(2)O in inter-ICU transports; p < 0.001. For cuff pressure assessment by the intubating team, a manometer had been applied in 2 of 59 emergency transfers and in 20 of 34 inter-ICU transports (method was unknown for 4 cases each). If a manometer was used, median cuff pressure was 27 (20.0/30.0) cmH(2)O, if not 70 (47.3/102.8) cmH(2)O; p < 0.001. CONCLUSIONS: Cuff pressures in the pre-hospital setting and in intensive care units are often too high. Interestingly, there is no significant difference between non-anaesthesia and anaesthesia personnel. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. This method seems to be the only feasible one and is recommended for general use.
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spelling pubmed-42350182014-11-19 Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem? Harm, Falko Zuercher, Mathias Bassi, Marco Ummenhofer, Wolfgang Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers’ professional background. METHODS: Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an emergency department to a higher facility. RESULTS: This study included 101 patients scheduled for aeromedical transport. Median cuff pressure measured at handover was 45 (25.0/80.0) cmH(2)O; range, 8-120 cmH(2)O. There was no difference between patient characteristics and tracheal tube-size or whether anaesthesia personnel or non-anaesthesia personnel inflated the cuff (30 (24.8/70.0) cmH(2)O vs. 50 (28.0/90.0) cmH(2)O); p = 0.113. With regard to mission type (63 patients underwent an emergency transfer, 38 patients an ICU transport), median cuff pressure was different: 58 (30.0/100.0) cmH(2)O in emergency transfers vs. 30 (20.0/45.8) cmH(2)O in inter-ICU transports; p < 0.001. For cuff pressure assessment by the intubating team, a manometer had been applied in 2 of 59 emergency transfers and in 20 of 34 inter-ICU transports (method was unknown for 4 cases each). If a manometer was used, median cuff pressure was 27 (20.0/30.0) cmH(2)O, if not 70 (47.3/102.8) cmH(2)O; p < 0.001. CONCLUSIONS: Cuff pressures in the pre-hospital setting and in intensive care units are often too high. Interestingly, there is no significant difference between non-anaesthesia and anaesthesia personnel. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. This method seems to be the only feasible one and is recommended for general use. BioMed Central 2013-12-04 /pmc/articles/PMC4235018/ /pubmed/24304522 http://dx.doi.org/10.1186/1757-7241-21-83 Text en Copyright © 2013 Harm et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Harm, Falko
Zuercher, Mathias
Bassi, Marco
Ummenhofer, Wolfgang
Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title_full Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title_fullStr Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title_full_unstemmed Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title_short Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
title_sort prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235018/
https://www.ncbi.nlm.nih.gov/pubmed/24304522
http://dx.doi.org/10.1186/1757-7241-21-83
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