Endotracheal tube cuff pressure management in adult critical care units

Abstract

Background. The monitoring of endotracheal tube (ETT) cuff pressure in intubated patients is important in preventing complications related to cuff over- and under-inflation. Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional nurses from adult CCUs in the public and private healthcare sectors in the Nelson Mandela Metropole, Eastern Cape, South Africa, using a structured self-administered questionnaire based on a literature review. Results. The survey response was 75% (100/134). Practice variances included the frequency of cuff pressure monitoring: only 52% of respondents performed cuff pressure measurements every 6 - 12 hours; 32% reported performing measurements at 2 - 4 hourly intervals; 15% only assessed cuff pressure when a leak occurred; and 1% never monitored cuff pressure. Of the 100 respondents, 37% used the cuff pressure measurement (CPM) method, 24% used the palpation method or listened to air leaks, and 22% used minimal occlusive volume (MOV). None of the respondents used the minimal leak technique (MLT). Only 20% of the respondents maintained cuff pressures at 18 - 22 mmHg. Thirty-one per cent indicated that they still performed the practice of cuff deflation and re-inflation before and after suctioning. There were incongruities related to the management of air leaks and the amount of air instilled. Conclusion. Practice variances were noted among the professional nurses, especially in the private healthcare sector. The lack of evidence-based clinical decision-making related to cuff pressure management in mechanically ventilated patients was evident. Best practice recommendations need to be used effectively when performing ETT cuff pressure management, to reduce practice variance, standardise safe patient care, and minimise complications.