Monitoring Tracheal Tube Cuff Pressures in the ICU Can Prevent Injury

“Despite increasing awareness among intensivists and respiratory therapists and more widespread use of low-pressure, high-volume cuffs, the incidence of tracheal tube cuff overinflation remains high in the contemporary American intensive care unit [ICU],” said Luc Morris, MD, from the Head and Neck Service in the Department of Otolaryngology at New York University School of Medicine during his scientific session presentation at the April 2007 meeting of the American Broncho-Esophagological Association at the Combined Otolaryngology Spring Meeting.

“This is a public health issue that otolaryngologists need to take the lead in,” continued Dr. Morris, whose paper was published in the August Annals of Otology, Rhinology, and Laryngology. “We are the airway doctors who take care of these patients when they come to us short of breath with tracheal stenosis, long after they have left the ICU. Every day, a large percentage of intubated and tracheotomized patients in our hospitals are experiencing tracheal injury. We have put the responsibility of preventing this problem on the shoulders of practitioners who are busy with other issues, and who have a hard time prioritizing this issue, because they do not see the sequelae of high cuff pressures.”

Prolonged intubation with cuffed tracheal tubes is common in ICU patients requiring mechanical ventilation. Although perioral endotracheal tubes are routinely converted to tracheotomy tubes, both types of cuffed tubes exert pressure against tracheal mucosa. Cuff pressure is a recognized risk factor for tracheal injury and subsequent tracheal stenosis.1–4 Although international studies report a 55% to 62% incidence of cuff overinflation among ICU patients,5,6 there are no data on tracheotomy tubes and no recent data from ICUs in the United States.