title: Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques.
abstract: OBJECTIVE
  We sought to determine the ability of paramedics to inflate endotracheal tube cuffs within safe pressure limits as well as to estimate the pressure of previously inflated endotracheal tube cuffs by palpation of the pilot balloon.
  
  
  METHODS
  Using a tracheal simulation model, we conducted a prospective, observational, cross-sectional simulation study of licensed, practicing paramedics. This included evaluation of their ability to inflate the cuff of an endotracheal tube to a safe pressure, defined as < or = 25 cm H(2)O, as well as to identify excessive intracuff pressure in previously inflated ETT cuffs by palpation of the pilot balloon.
  
  
  RESULTS
  Fifty-three paramedics were sampled. The average pressure generated by inflating the endotracheal tube cuff was > 108 cm H(2)O. Participants were only 13% sensitive detecting over inflated endotracheal tube cuffs (95% CI 7.3-17.8).
  
  
  CONCLUSIONS
  Participants were unable to inflate endotracheal tube cuff to safe pressures and were unable to identify endotracheal tube cuffs with excessive intracuff pressure by palpation. Clinicians should consider using devices such as manometers to facilitate safe inflation and accurate measurement of endotracheal tube cuff pressure.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Parwani
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hoffman
authors.forename: Allison
authors.initials: A
authors.lastname: Russell
authors.forename: Chetan
authors.initials: C
authors.lastname: Bharel
authors.forename: Christine
authors.initials: C
authors.lastname: Preblick
authors.forename: In-Hei
authors.initials: IH
authors.lastname: Hahn
mesh_terms: D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D004868:Equipment Failure; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D011446:Prospective Studies; D011787:Quality of Health Care