Tracheal tube cuff pressure monitoring: assessing current practice in critically ill patients at Chris Hani Baragwanath Academic Hospital

Abstract

Background Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. Objectives To determine the frequency of tracheal tube cuff pressure measurements (CPM), the range of CP and explore nursing knowledge regarding CP monitoring. Methods Frequency of CPM was assessed using a prospective intensive care unit (ICU) chart review. An interventional component of CPM was performed next. Finally a self-administered questionnaire was completed by nurses. Results Chart reviews and CPM were completed on 304 charts from 61 patients. Patients’ ages ranged from one to 71 years, with a male preponderance (1.5:1). Eighty seven percent of charts did not have a documented CPM and only 12 charts had at least one measurement per shift. Only 17% of CP were within the recommended range, with 59% being low. The nursing questionnaire was administered to 75 professional nurses with a response rate of 51%. Intensive care nursing experience ranged from 3 to 35 years with 92% being critical care trained. Seventy two percent of respondents reported measuring CP at least once per shift and knew the recommended cuff pressure range. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion Current practice requires urgent revision. Development of a nursing guideline together with in-service training may improve compliance with CPM and potentially decrease complications that arise from abnormal cuff pressures.