Endotracheal Tube (ETT) Cuff Pressure Assessment - Feel versus Measurement

Background: Mechanical ventilation is a life-saving intervention. The insertion of an ETT is necessary to perform this modality. Accurately managing ETT cuff pressure exerted is paramount to preventing tissue damage/long-term complications. Method: This study evaluated ETT cuff pressures as a consequence of management without use of cuff manometry. US Army Special Operations Aviation Regiment (SOAR) medics were instructed to perform intubation in a simulated airway model. After intubation subjects were instructed to fill ETT cuff with air to what they considered to be acceptable without the use of a cuff manometer. Cuff pressure were measured with a manometer. This procedure was completed three times. Pressure measurements were recorded and compared between subjects and to the accepted range of 20-30 centimeter (cm) water (H2O). Results: Pressure range was 1 - 203 cm H2O with 97% being outside the accepted range and 92% were greater than 30 cm H2O. Conclusions: The results were not within acceptable ranges. The consistently high pressures measured in the cuffs may cause tracheal injuries. A simple and accurate method to measure cuff pressures by these caregivers in austere environments is needed to prevent tracheal injuries due to excess ETT cuff pressure in intubated casualties.