Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg academic hospitals
Date
2014
Authors
Gilliland, Lizil
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Abstract
Background: Endotracheal tubes (ETTs) play an integral part in anaesthesia. ETT cuff pressure commonly exceeds the recommended range of 20 - 30 cm H₂0 during anaesthesia. This can lead to serious morbidity. No objective means of ETT cuff pressure monitoring is available in the operating theatres of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). The ETT cuff pressure of patients undergoing general anaesthesia is therefore unknown.
Aim: The aim of this study was to determine what the actual ETT cuff pressures were of patients receiving general anaesthesia at CMJAH and CHBAH and to document the cuff inflation techniques that were used to achieve these pressures.
Method: ETT cuff pressure of 96 adult patients undergoing general anaesthesia without nitrous oxide at CMJAH and CHBAH were measured. A RUSCH Endotest aneroid manometer was used to measure ETT cuff pressure in size 7.0 – 8.5 mm ETTs. The cuff inflation technique that was used by the anaesthetist was also documented. Anaesthetists were blinded to the study.
Results: The mean ETT cuff pressure recorded was 47.5 cm H₂0 (range 10 –120 cm H₂0). ETT cuff pressures exceeded 30 cm H₂0 in 64.58% of patients and 18.75% of patients had ETT cuff pressures within the recommended range of 20 - 30 cm H₂0. There was no statistically significant difference between the ETT cuff pressures measured at the two hospitals (p=0.2480). Minimal occlusive volume was the most frequent technique used to inflate the ETT cuff (37.5%), this was followed by a predetermined volume of air in 31.25% of cases and palpation of the pilot balloon (27.08%). There was no statistical significant difference between the ETT cuff pressure measured and the inflation technique.
Conclusion: ETT cuff pressures of patients undergoing general anaesthesia at two Johannesburg Academic hospitals were high. ETT cuff pressure should routinely be measured using an aneroid manometer.