title: Estimation of tracheostomy tube cuff pressure by pilot balloon palpation.
abstract: Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer.A study to compare these two methods, using the manometer as the reference standard, was then carried out. The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff.Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.
authors.affiliation: Department of Otolaryngology, St Mary's Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Faris
authors.forename: E
authors.initials: E
authors.lastname: Koury
authors.forename: J
authors.initials: J
authors.lastname: Philpott
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: N
authors.initials: N
authors.lastname: Tolley
authors.forename: A
authors.initials: A
authors.lastname: Narula
mesh_terms: D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008365:Manometry; D010173:Palpation / Q000379:methods*; D011312:Pressure; D015203:Reproducibility of Results; D014132:Trachea; D014139:Tracheostomy / Q000295:instrumentation*; D006113:United Kingdom