Elevated endotracheal tube cuff pressure in the pediatric emergency department

Objective: The objective of this study was to evaluate endotracheal tube cuff pressure after emergency intubation and identify variables associated with an elevated cuff pressure. Methods: This was a prospective cohort study of intubated patients in the emergency department of Nationwide Children's Hospital. The primary study outcome, cuff pressure, was measured via manometer. Clinical details related to the intubation were collected and analyzed as secondary outcomes. Results: Of the 104 patients enrolled, cuff pressure was 30 cmH₂O in 59 (57%); exceeding the recommended safe upper limit. The average cuff pressure was 38 cmH₂O for the entire cohort. Patients who had their endotracheal tube cuff inflated by a respiratory therapist tended to be exposed to a lower cuff pressure. Conclusions: More than half of patients in this study were exposed to a cuff pressure greater than the safe upper limit. Our analysis of secondary outcomes suggests that patient care could be improved by having certified respiratory therapists inflate the endotracheal tube cuffs of intubated children.