title: Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range.
abstract: BACKGROUND
  Endotracheal tube cuff pressure must be kept within an optimal range that ensures ventilation and prevents aspiration while maintaining tracheal perfusion.
  
  
  OBJECTIVE
  To test the effect of an intervention (adding or removing air) on the proportion of time that cuff pressure was between 20 and 30 cm H(2)O and to evaluate changes in cuff pressure over time.
  
  
  METHODS
  A repeated-measure crossover design was used to study 32 orally intubated patients receiving mechanical ventilation for two 12-hour shifts (randomized control and intervention conditions). Continuous cuff pressure monitoring was initiated, and the pressure was adjusted to a minimum of 22 cm H(2)O. Caregivers were blinded to cuff pressure data, and usual care was provided during the control condition. During the intervention condition, cuff pressure alarm or clinical triggers guided the intervention.
  
  
  RESULTS
  Most patients were men (mean age, 61.6 years). During the control condition, 51.7% of cuff pressure values were out of range compared with 11.1% during the intervention condition (P < .001). During the intervention, a mean of 8 adjustments were required, mostly to add air to the endotracheal tube cuff (mean 0.28 [SD, 0.13] mL). During the control condition, cuff pressure decreased over time (P < .001).
  
  
  CONCLUSIONS
  The intervention was effective in maintaining cuff pressure within an optimal range, and cuff pressure decreased over time without intervention. The effect of the intervention on outcomes such as ventilator-associated pneumonia and tracheal damage requires further study.
authors.affiliation: University of Central Florida in Orlando, 32826, USA. msole@mail.ucf.edu
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Sole
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Su
authors.forename: Steve
authors.initials: S
authors.lastname: Talbert
authors.forename: Daleen Aragon
authors.initials: DA
authors.lastname: Penoyer
authors.forename: Samar
authors.initials: S
authors.lastname: Kalita
authors.forename: Edgar
authors.initials: E
authors.lastname: Jimenez
authors.forename: Jeffery E
authors.initials: JE
authors.lastname: Ludy
authors.forename: Melody
authors.initials: M
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000399:Air Pressure; D058109:Airway Management / Q000295:instrumentation*; D018592:Cross-Over Studies; D004496:Education, Continuing; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods; D053120:Respiratory Aspiration / Q000517:prevention & control; D015144:Southeastern United States