Document Detail

Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range.
MedLine Citation:
PMID:  21362715     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endotracheal tube cuff pressure must be kept within an optimal range that ensures ventilation and prevents aspiration while maintaining tracheal perfusion.
OBJECTIVES: To test the effect of an intervention (adding or removing air) on the proportion of time that cuff pressure was between 20 and 30 cm H(2)O and to evaluate changes in cuff pressure over time.
METHODS: A repeated-measure crossover design was used to study 32 orally intubated patients receiving mechanical ventilation for two 12-hour shifts (randomized control and intervention conditions). Continuous cuff pressure monitoring was initiated, and the pressure was adjusted to a minimum of 22 cm H(2)O. Caregivers were blinded to cuff pressure data, and usual care was provided during the control condition. During the intervention condition, cuff pressure alarm or clinical triggers guided the intervention.
RESULTS: Most patients were men (mean age, 61.6 years). During the control condition, 51.7% of cuff pressure values were out of range compared with 11.1% during the intervention condition (P < .001). During the intervention, a mean of 8 adjustments were required, mostly to add air to the endotracheal tube cuff (mean 0.28 [SD, 0.13] mL). During the control condition, cuff pressure decreased over time (P < .001).
CONCLUSIONS: The intervention was effective in maintaining cuff pressure within an optimal range, and cuff pressure decreased over time without intervention. The effect of the intervention on outcomes such as ventilator-associated pneumonia and tracheal damage requires further study.
Mary Lou Sole; Xiaogang Su; Steve Talbert; Daleen Aragon Penoyer; Samar Kalita; Edgar Jimenez; Jeffery E Ludy; Melody Bennett
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American journal of critical care : an official publication, American Association of Critical-Care Nurses     Volume:  20     ISSN:  1937-710X     ISO Abbreviation:  Am. J. Crit. Care     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-02     Completed Date:  2011-07-20     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  9211547     Medline TA:  Am J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  109-17; quiz 118     Citation Subset:  IM; N    
University of Central Florida in Orlando, 32826, USA.
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MeSH Terms
Aged, 80 and over
Air Pressure*
Airway Management / instrumentation*
Cross-Over Studies
Education, Continuing
Equipment Failure*
Intubation, Intratracheal / instrumentation*
Middle Aged
Respiration, Artificial / methods
Respiratory Aspiration / prevention & control
Southeastern United States
Grant Support
Comment In:
Am J Crit Care. 2011 Nov;20(6):421-2; author reply 422   [PMID:  22045130 ]
Am J Crit Care. 2011 Nov;20(6):422-3; author reply 423-4   [PMID:  22045132 ]

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