title: Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated patients.
abstract: BACKGROUND
  Maintaining the cuff pressure of endotracheal tubes (ETTs) within 20-30 cmH2O is a standard practice. The aim of the study was to evaluate the effectiveness of standard practice in maintaining cuff pressure within the target range.
  
  
  METHODS
  This was a prospective observational study conducted in a tertiary-care intensive care unit, in which respiratory therapists (RTs) measured the cuff pressure 6 hourly by a handheld manometer. In this study, a research RT checked cuff pressure 2-4 h after the clinical RT measurement. Percentages of patients with cuff pressure levels above and below the target range were calculated. We identified predictors of low-cuff pressure.
  
  
  RESULTS
  We analyzed 2120 cuff-pressure measurements. The mean cuff pressure was 27 ± 2 cmH2O by the clinical RT and 21 ± 5 cmH2O by the research RT (p < 0.0001). The clinical RT documented that 98.0 % of cuff pressures were within the normal range. The research RT found the cuff pressures to be within the normal range in only 41.5 %, below the range in 53 % and above the range in 5.5 %. Low cuff pressure was found more common with lower ETT size (OR, 0.34 per 0.5 unit increase in ETT size; 95 % CI, 0.15-0.79) and with lower peak airway pressure (OR per one cm H2O increment, 0.93; 95 % CI, 0.87-0.99) on multivariate analysis.
  
  
  CONCLUSIONS
  Cuff pressure is frequently not maintained within the target range with low-cuff pressure being very common approximately 3 h after routine measurements. Low cuff pressure was associated with lower ETT size and lower peak airway pressure. There is a need to redesign the process for maintaining cuff pressure within the target range.
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. Amer.md.rrt@gmail.com.
authors.forename: Amer R
authors.initials: AR
authors.lastname: Alzahrani
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. AbbasiSh@ngha.med.sa.
authors.forename: Shatha
authors.initials: S
authors.lastname: Al Abbasi
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. AbahoussinO@ngha.med.sa.
authors.forename: Othman Khalid
authors.initials: OK
authors.lastname: Abahoussin
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. ShehriTa@ngha.med.sa.
authors.forename: Tariq Othman
authors.initials: TO
authors.lastname: Al Shehri
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. aldorzih@yahoo.com.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. hani_t@hotmail.com.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. sadatmu@ngha.med.sa.
authors.forename: Musharaf
authors.initials: M
authors.lastname: Sadat
authors.affiliation: Intensive Care Department; King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. yaseenarabi@yahoo.com.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011312:Pressure; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D014139:Tracheostomy / Q000295:instrumentation* / Q000379:methods