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Endotracheal Tube Cuff Pressure: Changes Associated with Activity and over Time
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2009 |
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| PURPOSE: Critically ill patients often require an endotracheal tube (ETT) to facilitate airway management and mechanical ventilation. Little is known about the variability of ETT cuff pressure (pcuff) in response to patient care and activities, and in the period between intermittent measurements (usually every 8 to 12 hours). The purposes of this study were to 1) assess changes in pcuff associated with routine care and patient activities, and 2) describe the natural history of ETT pcuff over time. BACKGROUND: The pcuff must be maintained within a narrow therapeutic range. Pcuff is often measured and adjusted once per shift. Little is known about pcuff in the interval between intermittent measures. Factors that decrease pcuff (activity or time) increase the risk for aspiration and ventilator-associated pneumonia. If pcuff is too high, the risk for tracheal damage increases. This study adds to the body of knowledge related to pcuff and will assist in designing interventions to improve patient outcomes. METHODS: This research is an analysis of data from a crossover study that tested an intervention to maintain pcuff; Pcuff was monitored continuously during a 12-hour shift for two consecutive days via a transducer and pressure monitor. Critically ill subjects who were orally intubated (n=32) were enrolled; changes over time were assessed in 29 subjects who had data collected during the control day. The Pcuff was adjusted to a minimum of 22 cm H2O at the beginning of the shift, and monitoring was begun. Patient activities (e.g., turning, coughing, suctioning) were recorded by a research assistant on a tablet computer using software (Spectator GO! Biobserve, Bonn, Germany) that captures real-time data. RESULTS: Subjects were aged 62 +/- 20 years, male (n=25), and intubated for 4 +3 days. To compare the variation in pcuff during activity, a dataset consisting of repeated measures of variations during activities was compiled; data were compared using a generalized estimation equation method. Significant increases in variation of pcuff (p < .05) were noted with ETT suction, turning, movement, coughing, and procedures. Significant decreases were found after medication for pain or agitation. As a natural history model for pcuff, the change pattern over time (control day) was assessed. A linear model was fit by regressing pcuff on time for each patient; values decreased significantly over time (p< .0000). CONCLUSIONS: The pcuff was dynamic and changed frequently. Many activities increased pcuff; values quickly returned to baseline. Pcuff decreased after administration of medications, which may be related to a higher sedation level or physiological effects on the airway; clinical signs such as low exhaled volume alarm or audible leak were not often seen. Since the pcuff decreased over time, determining the optimum pressure to adjust the pcuff, and frequency of assessment to prevent complications, is needed. 2009 National Teaching Institute Research Abstracts. Am J Crit Care 2009 18(3) e1-e17. http://ajcc.aacnjournals.org/cgi/reprint/18/3/e1. Accessed June 10, 2009. |
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Primary Investigator
Mary Sole
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P.I. Institution Name
University of Central Florida College of Nursing
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Contact Address
Orlando, FL
USA
Contact E-mail
msole@mail.ucf.edu
Contact Telephone
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Secondary Investigators
Elizabeth D. Penoyer; Xiaogang Su; Samar Kalita; Melody Bennett; Jeffery Ludy; Steven Talbert; Edgar Jimenez; Scott Mercado
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