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Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS

INTRODUCTION: Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopt...

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Autores principales: Weisberg, Stacy N., McCall, Jonathan C., Tennyson, Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468068/
https://www.ncbi.nlm.nih.gov/pubmed/28611883
http://dx.doi.org/10.5811/westjem.2017.3.32078
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author Weisberg, Stacy N.
McCall, Jonathan C.
Tennyson, Joseph
author_facet Weisberg, Stacy N.
McCall, Jonathan C.
Tennyson, Joseph
author_sort Weisberg, Stacy N.
collection PubMed
description INTRODUCTION: Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures. This study aims to explore the relationship between altitude and ETT cuff pressures in a helicopter air-medical transport program. METHODS: ETT cuffs were initially inflated in a nonstandardized manner and then adjusted to a pressure of 25 cmH(2)O. The pressure was again measured when the helicopter reached maximum altitude. A final pressure was recorded when the helicopter landed at the receiving facility. RESULTS: We enrolled 60 subjects in the study. The mean for initial tube cuff pressures was 70 cmH(2)O. Maximum altitude for the program ranged from 1,000–3,000 feet above sea level, with a change in altitude from 800–2,480 feet. Mean cuff pressure at altitude was 36.52 ± 8.56 cmH(2)O. Despite the significant change in cuff pressure at maximum altitude, there was no relationship found between the maximum altitude and the cuff pressures measured. CONCLUSION: Our study failed to demonstrate the expected linear relationship between ETT cuff pressures and the maximum altitude achieved during typical air-medical transportation in our system. At altitudes less than 3,000 feet above sea level, the effect of altitude change on ETT pressure is minimal and does not require a change in practice to saline-filled cuffs.
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spelling pubmed-54680682017-06-13 Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS Weisberg, Stacy N. McCall, Jonathan C. Tennyson, Joseph West J Emerg Med Prehospital Care INTRODUCTION: Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures. This study aims to explore the relationship between altitude and ETT cuff pressures in a helicopter air-medical transport program. METHODS: ETT cuffs were initially inflated in a nonstandardized manner and then adjusted to a pressure of 25 cmH(2)O. The pressure was again measured when the helicopter reached maximum altitude. A final pressure was recorded when the helicopter landed at the receiving facility. RESULTS: We enrolled 60 subjects in the study. The mean for initial tube cuff pressures was 70 cmH(2)O. Maximum altitude for the program ranged from 1,000–3,000 feet above sea level, with a change in altitude from 800–2,480 feet. Mean cuff pressure at altitude was 36.52 ± 8.56 cmH(2)O. Despite the significant change in cuff pressure at maximum altitude, there was no relationship found between the maximum altitude and the cuff pressures measured. CONCLUSION: Our study failed to demonstrate the expected linear relationship between ETT cuff pressures and the maximum altitude achieved during typical air-medical transportation in our system. At altitudes less than 3,000 feet above sea level, the effect of altitude change on ETT pressure is minimal and does not require a change in practice to saline-filled cuffs. Department of Emergency Medicine, University of California, Irvine School of Medicine 2017-06 2017-05-15 /pmc/articles/PMC5468068/ /pubmed/28611883 http://dx.doi.org/10.5811/westjem.2017.3.32078 Text en Copyright: © 2017 Weisberg et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Prehospital Care
Weisberg, Stacy N.
McCall, Jonathan C.
Tennyson, Joseph
Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title_full Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title_fullStr Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title_full_unstemmed Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title_short Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS
title_sort altitude-related change in endotracheal tube cuff pressures in helicopter ems
topic Prehospital Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468068/
https://www.ncbi.nlm.nih.gov/pubmed/28611883
http://dx.doi.org/10.5811/westjem.2017.3.32078
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