Author(s)
Abie Mendelsohn, MD
Laith Mukdad, BS
Anahat Dhillon, MD
Affiliation(s)
UCLA Voice Center for Medicine
Abstract:
BACKGROUND: High endotracheal tube cuff pressures increase post-intubation dysphagia, dysphonia, and stenosis. Published guidelines recommend endotracheal tube pressures to be =25cmH20. We therefore set out to identify the prevalence of intra-operative endotracheal tube cuff pressure within a high-volume surgical academic center. Secondarily, patient admission outcomes were analyzed for association with increased cuff pressures. METHODS: A prospective observational clinical study was performed. Exclusion criteria included age <16 years and intraoperative use of nitrous oxide. Elevated pressure was defined as >30cmH20. RESULTS: Of 156 surgical patients, 86 (55%) had elevated cuff pressures. No single surgical service line was more prone to increased pressures than another, but every surgical service demonstrated mean cuff pressure levels greater than 30cmH20. From the entire cohort no significant associations were found between increased intraoperative cuff pressures and hospital outcomes (admission length or dysphagia). When studying patients of high-risk surgical services only, 53 patients were identified from the cardiothoracic and liver surgical services. Within this subgroup, average cuff pressure was 35cmH20. 29 (54%) patients had an elevated cuff pressure. Nine (17%) patients developed postoperative dysphagia, 8 of whom had a elevated cuff pressures. After adjusting for clinical confounders, elevated cuff pressures were significantly associated with increased postoperative dysphagia (OR=39.05; p=0.045). CONCLUSION: There is substantial prevalence (>50%) of elevated intraoperative cuff pressures. Within this observational study, multivariate analysis demonstrated increased cuff pressure associated with postoperative dysphagia in high-risk surgical patients. The presented study will also demonstrate a simple method of cuff pressure measurement.