title: Cuff pressure monitoring by manual palpation in intubated patients: How accurate is it? A manikin simulation study.
abstract: BACKGROUND
  Endotracheal intubation (ETI) for mechanical ventilation has a central role in the Intensive Care Unit (ICU). ETI is one of the main risk factors for the development of ventilator-associated pneumonia (VAP) as its presence reduces the natural defences of the upper airway and allows the micro-suction of secretions in the airways. In order to minimise such complications, it is fundamental to maintain a suitable pressure inside the tube cuff.
  
  
  OBJECTIVE
  The main objective of the present study is to evaluate the effectiveness and reliability of palpation method, performed with the operators fingers, for detecting the tube cuff pressure.
  
  
  RESULTS
  The study was performed using a manikin to test the pressure of the ETT cuff, on a sample constituted by nurses employed in three Italian ICU from two different Umbrian hospitals. From a total of 68 participants, detection by palpation method revealed to be not correct in 68% of cases; in particular, only 10% of respondents can correctly detect a pressure in the recommended range (20-30cmH2O) using palpation. Moreover it was possible to highlight that the participation in emergency courses has a positive effect on the correct measurement of cuff pressure using the palpation method (V=0.501).
  
  
  CONCLUSIONS
  The study, in agreement with the literature, confirms the thesis that the palpation method is inadequate to determine an estimate of the pressure existing inside the cuff.
authors: Intensive Care Units, University Hospital of Perugia, "Santa Maria della Misericordia", Italy; Emergency and Critical Care Nursing at Perugia University, Italy. Electronic address: giustigiando@gmail.com.
authors: Gian Domenico
authors: GD
authors: Giusti
authors: University of Perugia, Italy.
authors: Cecilia
authors: C
authors: Rogari
authors: Department of Experimental Medicine, University of Perugia, Italy.
authors: Alessio
authors: A
authors: Gili
authors: Department of Anesthesiology, Intensive Care and Pain Therapy Centre, University Hospital of Perugia, "Santa Maria della Misericordia", Italy.
authors: Fulvio
authors: F
authors: Nisi
mesh_terms: D064648:Critical Care Nursing; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007558:Italy; D008348:Manikins; D008991:Monitoring, Physiologic / Q000379:methods*; D010173:Palpation; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D011312:Pressure; D012121:Respiration, Artificial / Q000451:nursing*
keywords: Cuffed endotracheal tube; Equipment-cuffs; Intensive care units; Intracuff pressure; Manikin study; Monitoring-cuff pressure; Nurse education