Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation.

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  • Additional Information
    • Affiliation:
      Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX
      Department of Respiratory Care, Texas State University, Round Rock, TX
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: While uncuffed endotracheal tubes have been traditionally used in the pediatric intensive care unit (PICU) population, evidence suggests cuffed endotracheal tubes (ETTs) are also safe to use within this population. Nevertheless, risks related to the use of cuffed ETTs increase when guidelines for safe and appropriate use are not followed. The primary goal of this study was to measure the cuff pressure (CP) using a cuff pressure manometer in a group of intubated pediatric subjects and determine the rate of cuff underinflation (<20 cm H20) or overinflation (>30 cm H20). The secondary aim was to determine whether CP was associated to gender, age, ETT size, and PICU length of stay prior to CP measurement. Methods: This was a prospective observational study conducted in an urban PICU. Pediatric subjects intubated with cuffed ETTs from 1 April 2017 to 1 May 2017 were included in the study. ETT CPs were measured daily to determine degree of inflation and compared according to gender, age, ETT size, and number of days intubated prior to CP measurement. Descriptive data are expressed as means and standard deviations. A two-sample t test was used to compare groups according to age, gender, and number of days present. And significance was considered with a P < 0.05. Pearson chi test was used to evaluate correlation between CPs and size of the ETT, number of days intubated prior to CP measurement, gender, and age. Results: Twenty pediatric subjects admitted during the study period were included for analysis. Eleven cuff measurements were found to be within normal limits, while 9 cuff measurements were found to be underinflated. No cases of overinflation were found. There were no significant associations between CP and size of the ETT (r = --0.08), number of days intubated prior to CP measurement (r = 0.19), gender (r = 0.09), and age (r = 0.12). Conclusions: Our study suggests that endotracheal cuff underinflation occurs often in the PICU population. Strategies to ensure appropriate ETT CPs are maintained are essential in the intubated pediatric population. Additional studies are necessary to develop interventions and training focused on the use of a cuff pressure manometer to measure CPs in the PICU by respiratory therapists and ensure consistent measurement using inter rater evaluation processes are needed.
    • Journal Subset:
      Allied Health; Blind Peer Reviewed; Canada; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed
    • ISSN:
      1205-9838
    • MEDLINE Info:
      NLM UID: 9617402
    • Publication Date:
      20200328
    • Publication Date:
      20200406
    • DOI:
      http://dx.doi.org/10.29390/cjrt-2019-018.
    • Accession Number:
      142359023
  • Citations
    • ABNT:
      WETTSTEIN, R. W. et al. Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation. Canadian Journal of Respiratory Therapy, [s. l.], p. 1–4, 2020. DOI 10.29390/cjrt-2019-018. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142359023. Acesso em: 9 ago. 2020.
    • AMA:
      Wettstein RW, Gardner DD, Wiatrek S, Ramirez KE, Restrepo RD. Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation. Canadian Journal of Respiratory Therapy. January 2020:1-4. doi:10.29390/cjrt-2019-018.
    • APA:
      Wettstein, R. W., Gardner, D. D., Wiatrek, S., Ramirez, K. E., & Restrepo, R. D. (2020). Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation. Canadian Journal of Respiratory Therapy, 1–4. https://doi.org/10.29390/cjrt-2019-018.
    • Chicago/Turabian: Author-Date:
      Wettstein, Richard W., Donna D. Gardner, Sadie Wiatrek, Kristina E. Ramirez, and Ruben D. Restrepo. 2020. “Endotracheal Cuff Pressures in the PICU: Incidence of Underinflation and Overinflation.” Canadian Journal of Respiratory Therapy, January, 1–4. doi:10.29390/cjrt-2019-018.
    • Harvard:
      Wettstein, R. W. et al. (2020) ‘Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation’, Canadian Journal of Respiratory Therapy, pp. 1–4. doi: 10.29390/cjrt-2019-018.
    • Harvard: Australian:
      Wettstein, RW, Gardner, DD, Wiatrek, S, Ramirez, KE & Restrepo, RD 2020, ‘Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation’, Canadian Journal of Respiratory Therapy, pp. 1–4, viewed 9 August 2020, .
    • MLA:
      Wettstein, Richard W., et al. “Endotracheal Cuff Pressures in the PICU: Incidence of Underinflation and Overinflation.” Canadian Journal of Respiratory Therapy, Jan. 2020, pp. 1–4. EBSCOhost, doi:10.29390/cjrt-2019-018.
    • Chicago/Turabian: Humanities:
      Wettstein, Richard W., Donna D. Gardner, Sadie Wiatrek, Kristina E. Ramirez, and Ruben D. Restrepo. “Endotracheal Cuff Pressures in the PICU: Incidence of Underinflation and Overinflation.” Canadian Journal of Respiratory Therapy, January 2020, 1–4. doi:10.29390/cjrt-2019-018.
    • Vancouver/ICMJE:
      Wettstein RW, Gardner DD, Wiatrek S, Ramirez KE, Restrepo RD. Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation. Canadian Journal of Respiratory Therapy [Internet]. 2020 Jan [cited 2020 Aug 9];1–4. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142359023