Tracheal tube cuff pressure in intubated patients undergoing general anaesthesia without cuff manometer monitoring: a prospective observational study

Abstract

Background: Ensuring appropriate pressure in the endotracheal tube cuff is a clinical imperative as both under-inflation and over-inflation are associated with complications and patient harm.
Objective: To determine whether the tracheal cuff pressure produced by our routine practice of subjective estimation were within the recommended range of 20-30 cmH₂O.
Design: A prospective observational study.
Setting: Operating theatre suites.
Participants: 141 patients who underwent general anaesthesia with cuffed endotracheal tube.
Methods: Following endotracheal intubation the tracheal cuffs were inflated by the anaesthesia provider conducting the procedure using their preferred cuff inflation technique. The manometer was subsequently used for objective determination of the cuff pressure. IBM Statistical Package for Social Science software, version 25, was used for data entry and analysis. Differences were considered significant when p < 0.05.
Results: The anaesthesia providers mostly used the pilot balloon palpation method for tracheal cuff inflation. The observed mean cuff pressure was 77.1 ± 31.1 cmH₂O. Only 6% (9/141) of the patients had cuff pressure within the recommended limits. Neither the professional experience of the anaesthesia provider nor the technique of cuff inflation was associated with proper tracheal cuff pressure estimation.
Conclusion: Tracheal cuff inflation by subjective estimation was grossly unreliable, irrespective of the anaesthesia provider or technique used.