Leak Associated With the Measurement of Endotracheal Tube Cuff Pressure: Three Methods of Measuring Cuff Pressure–A Bench Study

Abstract

Background: During mechanical ventilation, endotracheal tube cuff pressure must be controlled and monitored regularly to avoid complications such as air leak, aspiration, and tracheal injury. Common methods of measuring and adjusting cuff pressure are a syringe and stopcock connected to a manometer, a squeeze bulb connected to a manometer (Cufflator) and an electronic/pneumatic inflator/monitor (Intellicuff). The purpose of this study was to determine the changes in cuff pressure associated with those devices, in the laboratory. Methods: We measured the changes in cuff pressure 10 times each using the Posey Cufflator, a syringe and stopcock connected to a water manometer, and Intellicuff. Measurements were made in-vitro using an adult airway management trainer intubated with an 8.0 mm ID ETT. Cuff pressures were initially set to 30 cm H₂O with a water manometer in-line. The cuff inflation devices were disconnected, and cuff pressures were measured again. Data were analyzed using one-way ANOVA. Results: Cuff pressure decreased 1.9 + 0.31 cm H₂O upon reconnection of the Cufflator (P < .001). Cuff pressure decreased 0.51 + 0.19 cm H₂O when using a stopcock and a syringe (P < .001). Neither change was deemed clinically significant. When using the Intellicuff, the cuff pressure decreased 0.02 + 0.06 cm H₂O (P = .34). Conclusions: While there was a loss of cuff pressure using the Cufflator and a syringe and stopcock, neither change could be interpreted as clinically significant. The Intellicuff maintained cuff pressure closer to the initial pressure of the three methods. Future in vivo studies may confirm this in-vitro evaluation.