Abstract
Endotracheal intubation is performed in the prehospital
and emergency department (ED) environments by advanced
life support (ALS) paramedics and emergency doctors. Cuffed
endotracheal tubes (ETTs) are used in adults² and more recently in
children to ensure that the airway is protected, and to prevent air
leakage between the wall of the trachea and the ETT during positive pressure
ventilation. Cuffs are typically high volume, low pressure
in their design and have a safe working pressure of <30 cm H₂O in
adults and <20 cm H₂O in children.¹
Over-inflation of ETT cuffs to pressures exceeding 30 cm HO₂ may
result in serious complications including tracheal stenosis, tracheal
rupture and tracheo-oesophageal fistula. ³ Tracheal injury may occur
after as little as 15 minutes with ETT cuff pressures exceeding 27
cm H₂O. ² To avoid tracheal injury due to emergency intubation, it is
important that ETT cuff over-inflation is avoided in the pre-hospital
and ED phases of emergency care.
Although ETT cuff pressure manometry is optimal in determining
safe ETT cuff pressure, it is standard practice in the ED and in the
pre-hospital emergency care environment to assess ETT cuff pressure
using palpation of the cuff ’s pilot balloon – a qualitative technique
prone to subjective interpretation.