Methods Used for Endotracheal Tube Cuff Inflation and Pressure Verification in Veterinary Medicine: A Questionnaire on Current Practice

SIMPLE SUMMARY: Endotracheal intubation is the process whereby a tube is placed in the trachea during anaesthesia to assist breathing, administer anaesthetic gases and prevent fluids from entering the trachea. Endotracheal intubation is a routine procedure in veterinary anaesthesia, yet no guidelines exist for establishment of a sealed airway. Through an online survey of veterinary professionals who administer anaesthesia, we aimed to assess specific aspects of current practice of endotracheal intubation in veterinary medicine. The pressure in the cuff (a balloon at the end of the tube that, when inflated, contacts the trachea to seal off the airway) was measured by almost one-third of respondents in cats and dogs but by less than one-tenth of respondents in farm animals and horses. Respondents seemed to target a similar cuff inflation pressure, regardless of species, although a higher pressure was more often selected in horses compared to dogs, cats and farm animals. The preferred technique to verify cuff seal was the same in dogs, cats and farm animals, whereas in horses, a different technique was preferred. Cuff pressure measurement remains uncommon in veterinary anaesthesia. The development of recommendations for cuff inflation, including cuff pressure ranges for various species, can help to improve practice. ABSTRACT: Endotracheal intubation is a routine procedure in veterinary anaesthesia, yet no consensus guidelines exist for endotracheal tube (ETT) cuff inflation and pressure measurement. The aim of this study was to assess current practice of ETT cuff inflation and seal verification in veterinary medicine. An online questionnaire was distributed among veterinary professionals who administer anaesthesia, comprising six demographic and twelve ETT cuff-related questions per species. N = 348 questionnaires were completed. Cuff pressure was measured by 30% of respondents in cats, 32% in dogs and 9% in both farm animals and horses. Anaesthesia diplomates were not more likely to measure cuff pressure than others, except in cats (OR: 1.8; 95% CI: 1.1–2.9). The most frequently selected recommended range of cuff pressure was 20–30 cm H(2)O, regardless of species, although >30 cm H(2)O was selected significantly more often in horses compared to dogs, cats and farm animals. The preferred technique to verify cuff seal was minimal occlusive volume in dogs, cats and farm animals, whereas in horses, the preferred method was verification of normal capnogram waveform. ETT cuff pressure measurement remains uncommon in veterinary anaesthesia. The development of consensus recommendations for cuff inflation, including evidence-based target cuff pressure ranges for various species and different ETT models or materials, can help to improve practice.