A Prospective Clinical Audit of Endotracheal Tube Cuff Pressure Measurements in Ventilated ICU Patients at CWM Hospital
- Author:
Teokotai O-Alone Maea
1
;
Elizabeth Inaido-Lee
2
Author Information
1. Colonial War Memorial Hospital
2. College of Medicine, Nursing and Health Science, Fiji National University
- Publication Type:Journal Article
- From:
Fiji Medical Journal
2024;24(4):176-184
- CountryFiji
- Language:English
-
Abstract:
Introduction:It is well known that inappropriately inflated ETT cuff pressure may result in significant patient complications. Clinical guidelines recommend objective measurements of cuff pressure using standard manometric tools with regular monitoring to maintain ETT cuff pressure within the recommended range (20-30cmH2O). Estimation techniques in assessing cuff pressure are unreliable and patients may still be exposed to unfavourable pressure. The aim of this baseline study was to carry out a descriptive audit on the current practice to determine whether ETT cuffs are inflated to correct pressure, and to assess whether cuff pressure were routinely monitored by the nursing staff at the CWM Hospital ICU, over a 3 month period.
Method:An on-site prospective clinical audit that evaluated 47 ventilated ICU patients using convenience sampling. Auditor entered ICU without prior notice to carry out measurements using a single standard aneroid manometer and reviewed patient’s charts. Inclusion and exclusion criteria were used to identify patient’s eligibility into the study.
Results:More than 50% of ETT cuff pressures were out of range (8% low and 51% high pressure); only 41% were inflated to within the ideal cuff pressure (20-30cmH2O). There was no manometer available to ICU staff during the study period, therefore monitoring and documentation of cuff pressure was not possible. Pressure variabilities and often high cuff pressures were observed among patients who required prolonged intubation (>7 days). A potentially faulty ETT size was identified that require further evaluation.
Conclusion:The current practice on endotracheal tube cuff care at the Intensive Care Unit of CWM Hospital is below the recommended standard for best practice. Patients are exposed to unsafe ETT cuff pressure without objective measurements and regular monitoring. Staff training and availability of manometer are needed to improve current practice to ensure quality and safe patient care. Further audits may benefit patients, and a more comprehensive study to evaluate patient clinical outcome is recommended.
- Full text:FMJ 2024 v24 n01 176 - 184 - Audit of ETT Cuff Pressure Measurements.pdf
