title: Prospective observational measurement of tracheal tube cuff pressures in the emergency department.
abstract: BACKGROUND
  Tracheal mucosal blood flow is impaired when tracheal tube cuff pressure is above 30 cm of water, with the potential for tracheal mucosal necrosis. Previous studies have found excessive cuff pressures in simulated patients intubated by North American emergency physicians as well as patients intubated in the prehospital setting and emergency department (ED). This study assessed whether patients intubated in a UK prehospital setting or ED had excessive cuff pressures.
  
  
  METHODS
  Prospective observational study in five ED in southwest England over a 2-month period. All patients over 18 years and intubated in the prehospital setting or in the ED were included. Clinical staff independent of the patients' care recorded the following: age, sex, presenting complaint and indication for intubation, tube size and cuff pressure. Neither the paramedics nor the participating ED staff were aware of the study purpose. Cuff pressure measurements were recorded using a standardised cuff inflator pressure gauge.
  
  
  RESULTS
  61 patients were recruited. The median and mean cuff pressures were 58 and 62 cm of water, respectively. 75% of patients had a cuff pressure greater than 30 cm of water. The median cuff pressures in those patients intubated by senior emergency physicians, junior emergency physicians and paramedics were 70, 46 and 79 cm of water, respectively.
  
  
  CONCLUSIONS
  Excessive tracheal tube cuff pressures were demonstrated in the majority of patients intubated both in the prehospital setting and ED. This is in keeping with existing evidence. Early measurement and adjustment of cuff pressures is recommended for those patients who require ongoing care.
authors.affiliation: Emergency Department, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Chopra
authors.forename: Lewis
authors.initials: L
authors.lastname: Jones
authors.forename: Carole
authors.initials: C
authors.lastname: Boulanger
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
authors.forename: Ian
authors.initials: I
authors.lastname: Higginson
authors.forename: Dominic
authors.initials: D
authors.lastname: Williamson
authors.forename: Paul
authors.initials: P
authors.lastname: Younge
authors.forename: Gavin
authors.initials: G
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D010818:Practice Patterns, Physicians'; D011312:Pressure; D011446:Prospective Studies; D055815:Young Adult