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dc.contributor.authorTennyson, Joseph
dc.contributor.authorFord-Webb, Tucker
dc.contributor.authorWeisberg, Stacy
dc.contributor.authorLeBlanc, Donald
dc.date2022-08-11T08:09:46.000
dc.date.accessioned2022-08-23T16:42:48Z
dc.date.available2022-08-23T16:42:48Z
dc.date.issued2016-11-01
dc.date.submitted2017-02-10
dc.identifier.citationWest J Emerg Med. 2016 Nov;17(6):721-725. Epub 2016 Sep 13. <a href="http://dx.doi.org/10.5811/westjem.2016.8.30639">Link to article on publisher's site</a>
dc.identifier.issn1936-900X (Linking)
dc.identifier.doi10.5811/westjem.2016.8.30639
dc.identifier.pmid27833679
dc.identifier.urihttp://hdl.handle.net/20.500.14038/40166
dc.description.abstractINTRODUCTION: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. METHODS: We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. RESULTS: We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p < 0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. CONCLUSION: Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=27833679&dopt=Abstract">Link to Article in PubMed</a>
dc.rightsCopyright © 2016 Tennyson et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectEndotracheal intubation
dc.subjecthelicopter emergency medical services (HEMS) transport
dc.subjectEmergency Medicine
dc.titleEndotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport
dc.typeJournal Article
dc.source.journaltitleThe western journal of emergency medicine
dc.source.volume17
dc.source.issue6
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=3970&amp;context=oapubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/oapubs/2965
dc.identifier.contextkey9667413
refterms.dateFOA2022-08-23T16:42:48Z
html.description.abstract<p>INTRODUCTION: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS.</p> <p>METHODS: We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool.</p> <p>RESULTS: We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90). The mean ETT cuff pressure was 70 (95% CI= [61-80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p < 0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge.</p> <p>CONCLUSION: Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.</p>
dc.identifier.submissionpathoapubs/2965
dc.contributor.departmentDepartment of Emergency Medicine
dc.source.pages721-725


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Copyright © 2016 Tennyson et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
Except where otherwise noted, this item's license is described as Copyright © 2016 Tennyson et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.