OJAnes  Vol.3 No.10 , December 2013
Endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital
Abstract: Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.
Cite this paper: A. Antwi-Kusi, G. Boakye and W. Sam Awortwi, "Endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital," Open Journal of Anesthesiology, Vol. 3 No. 10, 2013, pp. 427-432. doi: 10.4236/ojanes.2013.310089.

[1]   A. Aitkenhead, “Test Book of Anaesthesia,” 5th Edition, Churchill Livingstone, London, 2007.

[2]   P. Sengupta, D. I. Sessler, P. Maglinger, S. Wells, A. Vogt, J. Durrani, et al., “Endotracheal Tube Cuff Pressure in Three Hospitals, and the Volume Required to Produce an Appropriate Cuff Pressure,” BMC Anesthesiology, Vol. 4, No. 1, 2004, p. 8.

[3]   Chanmugam, “Clinical Procedures in Emergency Medicine,” 4th Edition, Saunders, Philadelphia, 2004.

[4]   R. Fernandez, L. Blanch, J. Mancebo, N. Bonsoms and A. Artigas, “Endotracheal Tube Cuff Pressure Assessment: Pitfalls of Finger Estimation and Need for Objective Measurement,” Critical Care Medicine, Vol. 18, No. 12, 1990, pp. 1423-1426.

[5]   J. R. Braz, L. H. Navarro, I. H. Takata and P. Nascimento Jr., “Endotracheal Tube Cuff Pressure: Need for Precise Measurement,” Sao Paulo Medical Journal, Vol. 117, No. 6, 1999, pp. 243-247.

[6]   L. Trivedi, P. Jha, N. R. Bajiya and D. Tripathi, “We Should Care More about Intracuff Pressure: The Actual Situation in Government Sector Teaching Hospital,” Indian Journal of Anaesthesia, Vol. 54, No. 4, 2010, pp. 314-317.

[7]   R. D. Seegobin and G. L. van Hasselt, “Endotracheal Cuff Pressure and Tracheal Mucosal Blood Flow: Endoscopic Study of Effects of Four Large Volume Cuffs,” British Medical Journal (Clinical Research Edition), Vol. 288, No. 6422, 1984, pp. 965-968.

[8]   M. J. Silva, J. Aparício, T. Mota, J. Spratley and A. Ribeiro, “Ischemic Subglottic Damage Following a Short-Time Intubation,” European Journal of Emergency Medicine, Vol. 15, No. 6, 2008, pp. 351-353.

[9]   J. A. Curiel García, F. Guerrero-Romero and M. Rodríguez-Morán, “Cuff Pressure in Endotracheal Intubation: Should It Be Routinely Measured?” Gaceta Médica de México, Vol. 137, No. 2, 2001, pp. 179-182.

[10]   P. Pelc, T. Prigogine, P. Bisschop and A. Jortay, “Tracheoesophageal Fistula: Case Report and Review of Literature,” Acta Otorhinolaryngologica Belgica, Vol. 55, No. 4, 2001, pp. 273-278.

[11]   J. Stauffer, D. Olson and T. Petty, “Complications and Consequences of Tracheal Intubation and Tracheostomy,” The American Journal of Medicine, Vol. 70, No. 1, 1981, pp. 65-76.

[12]   V. Parwani, I. Hahn and R. Hoffmann, “Experienced Paramedics Cannot Inflate or Estimate Endotracheal Tube Cuff Pressure Using Standard Techniques,” Annals of Emergency Medicine, Vol. 48, No. 4, 2006, pp. 20-24.

[13]   A. Doyle, R. Santhirapala, M. Crowe, M. Blunt and P. Young, “The Pressure Exerted on the Tracheal Wall by Two Endotracheal Tube Cuffs: A Prospective Observational Bench-Top, Clinical and Radiological Study,” BMC Anesthesiology, Vol. 10, 2010, p. 21.

[14]   E. A. Loeser, D. L. Orr 2nd, G. M. Bennett and T. H. Stanley, “Endotracheal Tube Cuff Design and Postoperative Sore Throat,” Anesthesiology, Vol. 45, No. 6, 1976, pp. 684-687.

[15]   A. Gottschalk, M. A. Burmeister, I. Blanc, F. Schulz and T. Standl, “Rupture of the Trachea after Emergency Endotracheal Intubation,” Anasthesiol Intensivmed Notfallmed Schmerzther, Vol. 38, No. 1, 2003, pp. 59-61.

[16]   V. Nesek-Adam, V. Mrsic, D. Oberhofer, E. Grizelj-Stojcic, D. Kosuta and Z. Rasic, “Post-Intubation Long-Segment Tracheal Stenosis of the Posterior Wall: A Case Report and Review of the Literature,” Journal of Anesthesia, Vol. 24, No. 4, 2010, pp. 621-625.

[17]   R. Wason, P. Gupta and A. R. Gogia, “Bilateral Adductor Vocal Cord Paresis Following Endotracheal Intubation for General Anaesthesia,” Anaesth Intensive Care, Vol. 32, No. 3, 2004, pp. 417-418.

[18]   M. F. Reed and D. J. Mathisen, “Tracheoesophageal Fistula,” Chest Surgery Clinics of North America, Vol. 13, No. 2, 2003, pp. 271-289.

[19]   Y. Sanada, Y. Kojima and E. W. Fonkalsrud, “Injury of Cilia Induced by Tracheal Tube Cuffs,” Surgery, Gynecology & Obstetrics, Vol. 154, No. 5, 1982, pp. 648-652.

[20]   J. R. Bouvier, “Measuring Tracheal Tube Cuff Pressures —Tool and Technique,” Heart & Lung, Vol. 10, No. 4, 1981, pp. 686-690.

[21]   J. F. Berlauk, “Prolonged Endotracheal Intubation vs. Tracheostomy,” Critical Care Medicine, Vol. 14, No. 8, 1986, pp. 742-745.

[22]   R. J. Hoffman, V. Parwani and I.-H. Hahn, “Experienced Emergency Medicine Physicians Cannot Safely Inflate or Estimate Endotracheal Tube Cuff Pressure Using Standard Techniques,” American Journal of Emergency Medicine, Vol. 24, No. 2, 2006, pp. 139-143.

[23]   A. M. Black and R. D. Seegobin, “Pressures on Endotracheal Tube Cuffs,” Anaesthesia, Vol. 36, No. 5, 1981, pp. 498-511.

[24]   J. L. Stauffer, D. Olson and T. Petty, “Complications and Consequences of Tracheal Intubation and Tracheostomy: A Prospective Study of 150 Critically Adult Patients,” The American Journal of Medicine, Vol. 70, No. 1, 1981, pp. 65-76.

[25]   V. Parwani, R. J. Hoffman, A. Russell, C. Bharel, C. Preblick and I.-H. Hahn, “Practicing Paramedics Cannot Generate or Estimate Safe Endotracheal Tube Cuff Pressure Using Standard Techniques,” Prehospital Emergency Care, Vol. 11, No. 3, 2007, pp. 307-311.