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Background  Maintaining the cuff pressure of endotracheal tubes (ETTs) within 20–30 cmH 2 O is a standard practice. The aim of the study was to evaluate the effectiveness of standard practice in maintaining cuff pressure within the target range.    Methods  This was a prospective observational study conducted in a tertiary-care intensive care unit, in which respiratory therapists (RTs) measured the cuff pressure 6 hourly by a handheld manometer. In this study, a research RT checked cuff pressure 2–4 h after the clinical RT measurement. Percentages of patients with cuff pressure levels above and below the target range were calculated. We identified predictors of low-cuff pressure.    Results  We analyzed 2120 cuff-pressure measurements. The mean cuff pressure was 27 ± 2 cmH 2 O by the clinical RT and 21 ± 5 cmH 2 O by the research RT ( p  < 0.0001). The clinical RT documented that 98.0 % of cuff pressures were within the normal range. The research RT found the cuff pressures to be within the normal range in only 41.5 %, below the range in 53 % and above the range in 5.5 %. Low cuff pressure was found more common with lower ETT size (OR, 0.34 per 0.5 unit increase in ETT size; 95 % CI, 0.15–0.79) and with lower peak airway pressure (OR per one cm H 2 O increment, 0.93; 95 % CI, 0.87–0.99) on multivariate analysis.    Conclusions  Cuff pressure is frequently not maintained within the target range with low-cuff pressure being very common approximately 3 h after routine measurements. Low cuff pressure was associated with lower ETT size and lower peak airway pressure. There is a need to redesign the process for maintaining cuff pressure within the target range.

bmc anesthesiology

Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patients