References

Delorenzo A, Shepherd M, Andrew E, Jennings P, Bernard S, Smith K Endotracheal tube intracuff pressure changes in patients transported by a helicopter emergency medical service: a prospective observational study. Air Med J. 2021; 40:(4)216-219 https://doi.org/10.1016/j.amj.2021.04.002

Springer M, Johnson T, Eastlee C, Johnson J Retrospective review of initial endotracheal tube cuff pressures on interfacility transports. Air Med J. 2016; 35:(5)285-286 https://doi.org/10.1016/j.amj.2016.07.026

Klonner ME, Mattaliano G, Casoria V, Vogl C, Braun C Disposable airway pressure manometers for endotracheal tube cuff inflation. Animals (Basel). 2023; 13:(3) https://doi.org/10.3390/ani13030475

Clinical Practice

Continuous monitoring of cuffed tube pressure: a craft solution?

02 January 2025
Comment

Abstract

Establishing a definitive airway is crucial during the management of critically ill patients. Both in-hospital and out-of-hospital providers routinely use cuffed endotracheal tubes with just a syringe to achieve an ‘appropriate’ seal without measuring cuff pressure. However, several studies have shown that both over-inflated (pressure >30 cmH2O) and under-inflated (pressure <20 cmH2O) cuffs are associated with worse outcomes (Delorenzo et al, 2021).

Establishing a definitive airway is crucial during the management of critically ill patients. Both in-hospital and out-of-hospital providers routinely use cuffed endotracheal tubes with just a syringe to achieve an ‘appropriate’ seal without measuring cuff pressure. However, several studies have shown that both over-inflated (pressure >30 cmH2O) and under-inflated (pressure <20 cmH2O) cuffs are associated with worse outcomes (Delorenzo et al, 2021).

The tracheal mucosa, with an estimated capillary perfusion pressure of 35–40 cmH2O, can begin to develop ischaemia within just 15 minutes if the endotracheal cuff pressure exceeds 30 cmH2O2. To avoid the detrimental effects of over-inflation, several techniques and devices have been developed to assess intra-cuff pressure, such as commercial manometers, palpation techniques, and minimal occlusive volume assessments (Klonner et al, 2023). Among these, only the commercial manometer has proven to be effective in establishing optimal cuff pressure and seal (Delorenzo et al, 2021; Klonner et al, 2023).

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