Endotracheal tube cuff pressures in pediatric patients intubated before aeromedical transport.
OBJECTIVE
Prolonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H2O can cause complications. With increasing utilization of cuffed endotracheal tubes (ETTs) in pediatric patients comes the risk of overinflation. We evaluated the incidence of elevated ETTCP in pediatric patients intubated with cuffed ETTs, transported by a critical-care transport service and attempted to identify whether elevated ETTCP was associated with factors such as patient demographics, diagnostic category, and intubator credentials.


METHODS
In this prospective study, assessment of ETTCP was made upon transport crew arrival at the bedside. The study focused on a consecutive sample of pediatric patients undergoing transport with cuffed ETTs placed before transport team arrival. All patients had cuff pressures assessed by the same cuff manometry device. Pressures found to be greater than 30 cm H2O were corrected immediately.


RESULTS
Forty-one percent of cases met the a priori defined cutoff for elevated ETTCP of 30 cm H2O; 30% of those elevated cuff pressures were twice that cutoff (>60 cm H2O). There were no associations between high ETTCP and any of the following independent variables: demographics, physician versus nonphysician intubator, and intubation location (ie, scene vs emergency department vs intensive care unit).


CONCLUSIONS
A significant number of pediatric patients transported by a critical-care transport service had elevated ETTCP. Furthermore, there was no clear risk factor for elevated cuff pressures. This is further evidence that cuff pressures should be measured in all patients. Further research should focus on the effect of educational intervention and on the possible clinical results of elevated ETTCPs.
Tollefsen
William W
WW
Harvard Affiliated Emergency Medicine, Brigham and Women's Hospital/Massachusetts General Hospital, 75 Francis St, Neville House-236A, Boston, MA 02115, USA. wtollefsen@partners.org
Chapman
Jacob
J
Frakes
Michael
M
Gallagher
Michael
M
Shear
Melissa
M
Thomas
Stephen H
SH
D000293:Adolescent; D017732:Air Ambulances; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008365:Manometry; D011312:Pressure; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014133:Tracheal Diseases / Q000209:etiology / Q000517:prevention & control; D014456:Ulcer / Q000209:etiology / Q000517:prevention & control