Prevalence and predictors of out-of-range cuff pressure of endotracheal and tracheostomy tubes: a prospective cohort study in mechanically ventilated XXXX .

@entity1 @entity4358 @entity10020 @entity138
BACKGROUND: Maintaining the cuff pressure of endotracheal tubes (ETTs) within 20-30 @entity10020 O 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 @entity138 checked cuff pressure 2-4 h after the clinical RT measurement. Percentages of @entity1 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 @entity10020 O by the clinical RT and 21        5 @entity10020 O by the @entity138 (p   <   0.0001). The clinical RT documented that 98.0  % of cuff pressures were within the normal range. The @entity138 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 @entity4358 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.
