title: Monitoring tracheal tube cuff pressures in the intensive care unit: a comparison of digital palpation and manometry.
abstract: OBJECTIVE
  Tracheal tube cuff overinflation is a recognized risk factor for tracheal injury and stenosis. International studies report a 55% to 62% incidence of cuff overinflation among intensive care unit (ICU) patients. However, there are no data on tracheotomy tubes, and no recent data from ICUs in the United States. It is unknown whether routine cuff pressure measurement is beneficial. We sought to determine the incidence of cuff overinflation in the contemporary American ICU.
  
  
  METHODS
  We performed an Institutional Review Board-approved, prospective, observational study of endotracheal and tracheotomy tubes at 2 tertiary-care academic hospitals that monitor cuff pressure differently. At hospital A, cuff pressures are assessed by palpation; at hospital B, cuff pressures are measured via manometry. We audited cuff pressures in an unannounced fashion at these hospitals, using a handheld aneroid manometer. Cuffs were considered overinflated above 25 cm H2O.
  
  
  RESULTS
  We enrolled 115 patients: 63 at hospital A and 52 at hospital B. Overall, 44 patients (38%) were found to have overinflated cuffs. The incidence of overinflation was identical at the 2 hospitals (38%; p = .99). Of the endotracheal tubes, 43% were overinflated, as were 32% of the tracheotomy tubes (p = .24).
  
  
  CONCLUSIONS
  Despite increasing awareness among intensivists and respiratory therapists, the incidence of tracheal tube overinflation remains high, with both endotracheal and tracheotomy tubes. Our finding that the use of manometry to assess cuff pressures did not reduce the incidence of overinflation suggests that a more vigilant management protocol may be necessary.
authors.affiliation: Department of Otolaryngology, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Luc G
authors.initials: LG
authors.lastname: Morris
authors.forename: Richard A
authors.initials: RA
authors.lastname: Zoumalan
authors.forename: J David
authors.initials: JD
authors.lastname: Roccaforte
authors.forename: Milan R
authors.initials: MR
authors.lastname: Amin
mesh_terms: D004867:Equipment Design; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008365:Manometry / Q000379:methods*; D010173:Palpation / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D015203:Reproducibility of Results; D014140:Tracheotomy / Q000295:instrumentation*