PURPOSE: Critically-ill patients may require intubation and support with mechanical ventilation. Patients may fail extubation for a variety of reasons; deconditioning, poor lung compliance, altered mental status and airway trauma among others. Endotracheal tubes inserted in even the most controlled environments may traumatize the airway and lead to laryngeal edema. After intubation the cuff is inflated to recommended pressures of 20 to 30 cmH20, a pressure thought to provide sufficient seal and not compromise mucosal perfusion. There has been some thought that elevated cuff pressures may lead to laryngeal edema and subsequently extubation failure (defined as reintubation within 48 hours). The purpose of our study was to ascertain if there was a correlation between elevated endotracheal cuff pressures and failure to extubate successfully.
METHODS: Data was obtained prospectively between January 2009 and June 2010 in our adult 16 bed medical/surgical/neurosurgical ICU. Endotracheal cuff pressures were measured and recorded immediately prior to extubation. All mechanically ventilated patients admitted to our ICU were eligible. Extubation failure was defined as reintubation for any cause within 48 hours after extubation.
RESULTS: From January 2009 to June 2010 there were a total of 274 extubated patients in the ICU. Only 27 patients were classified as extubation failure and were reintubated within 48 hours. Data showed that the average cuff pressure’s for all intubated patients (prior to extubation) in the ICU was 21.98 cmH20, (range: 15- 34 cmH20). The average cuff pressure for patients who were reintubated within 48 hours was 22.74 cmH20 (range: 18-32cmH20).
CONCLUSIONS: In our study, variations in endotracheal cuff pressures commonly occur. Elevated endotracheal cuff pressures were not associated with extubation failure.
CLINICAL IMPLICATIONS: There doesn't seem to be a correlation between endotracheal cuff pressures and extubation failures.
DISCLOSURE: The following authors have nothing to disclose: Fariborz Rezai, Naleena Sidhu, Kristin Fless, Varun Chakravorty, Amar Patel, Paul Yodice
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