2.50
Hdl Handle:
http://hdl.handle.net/10755/157182
Category:
Abstract
Type:
Presentation
Title:
Endotracheal Tube Cuff Pressure: Changes Associated with Activity and over Time
Author(s):
Sole, Mary; Penoyer, Elizabeth D.; Su, Xiaogang; Kalita, Sumar; Bennett, Melody; Ludy, Jeffery; Talbert, Steven; Jimenezm Edgar; Mercado, Scott
Author Details:
Mary Sole, University of Central Florida College of Nursing, Orlando, Florida, USA, email: msole@mail.ucf.edu; Elizabeth D. Penoyer; Xiaogang Su; Samar Kalita; Melody Bennett; Jeffery Ludy; Steven Talbert; Edgar Jimenez; Scott Mercado
Abstract:
PURPOSE: Critically ill patients often require an endotracheal tube (ETT) to facilitate airway management and mechanical ventilation. Little is known about the variability of ETT cuff pressure (pcuff) in response to patient care and activities, and in the period between intermittent measurements (usually every 8 to 12 hours). The purposes of this study were to 1) assess changes in pcuff associated with routine care and patient activities, and 2) describe the natural history of ETT pcuff over time. BACKGROUND: The pcuff must be maintained within a narrow therapeutic range. Pcuff is often measured and adjusted once per shift. Little is known about pcuff in the interval between intermittent measures. Factors that decrease pcuff (activity or time) increase the risk for aspiration and ventilator-associated pneumonia. If pcuff is too high, the risk for tracheal damage increases. This study adds to the body of knowledge related to pcuff and will assist in designing interventions to improve patient outcomes. METHODS: This research is an analysis of data from a crossover study that tested an intervention to maintain pcuff; Pcuff was monitored continuously during a 12-hour shift for two consecutive days via a transducer and pressure monitor. Critically ill subjects who were orally intubated (n=32) were enrolled; changes over time were assessed in 29 subjects who had data collected during the control day. The Pcuff was adjusted to a minimum of 22 cm H2O at the beginning of the shift, and monitoring was begun. Patient activities (e.g., turning, coughing, suctioning) were recorded by a research assistant on a tablet computer using software (Spectator GO! Biobserve, Bonn, Germany) that captures real-time data. RESULTS: Subjects were aged 62 +/- 20 years, male (n=25), and intubated for 4 +3 days. To compare the variation in pcuff during activity, a dataset consisting of repeated measures of variations during activities was compiled; data were compared using a generalized estimation equation method. Significant increases in variation of pcuff (p < .05) were noted with ETT suction, turning, movement, coughing, and procedures. Significant decreases were found after medication for pain or agitation. As a natural history model for pcuff, the change pattern over time (control day) was assessed. A linear model was fit by regressing pcuff on time for each patient; values decreased significantly over time (p< .0000). CONCLUSIONS: The pcuff was dynamic and changed frequently. Many activities increased pcuff; values quickly returned to baseline. Pcuff decreased after administration of medications, which may be related to a higher sedation level or physiological effects on the airway; clinical signs such as low exhaled volume alarm or audible leak were not often seen. Since the pcuff decreased over time, determining the optimum pressure to adjust the pcuff, and frequency of assessment to prevent complications, is needed.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleEndotracheal Tube Cuff Pressure: Changes Associated with Activity and over Timeen_GB
dc.contributor.authorSole, Maryen_GB
dc.contributor.authorPenoyer, Elizabeth D.en_GB
dc.contributor.authorSu, Xiaogangen_GB
dc.contributor.authorKalita, Sumaren_GB
dc.contributor.authorBennett, Melodyen_GB
dc.contributor.authorLudy, Jefferyen_GB
dc.contributor.authorTalbert, Stevenen_GB
dc.contributor.authorJimenezm Edgaren_GB
dc.contributor.authorMercado, Scotten_GB
dc.author.detailsMary Sole, University of Central Florida College of Nursing, Orlando, Florida, USA, email: msole@mail.ucf.edu; Elizabeth D. Penoyer; Xiaogang Su; Samar Kalita; Melody Bennett; Jeffery Ludy; Steven Talbert; Edgar Jimenez; Scott Mercadoen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157182-
dc.description.abstractPURPOSE: Critically ill patients often require an endotracheal tube (ETT) to facilitate airway management and mechanical ventilation. Little is known about the variability of ETT cuff pressure (pcuff) in response to patient care and activities, and in the period between intermittent measurements (usually every 8 to 12 hours). The purposes of this study were to 1) assess changes in pcuff associated with routine care and patient activities, and 2) describe the natural history of ETT pcuff over time. BACKGROUND: The pcuff must be maintained within a narrow therapeutic range. Pcuff is often measured and adjusted once per shift. Little is known about pcuff in the interval between intermittent measures. Factors that decrease pcuff (activity or time) increase the risk for aspiration and ventilator-associated pneumonia. If pcuff is too high, the risk for tracheal damage increases. This study adds to the body of knowledge related to pcuff and will assist in designing interventions to improve patient outcomes. METHODS: This research is an analysis of data from a crossover study that tested an intervention to maintain pcuff; Pcuff was monitored continuously during a 12-hour shift for two consecutive days via a transducer and pressure monitor. Critically ill subjects who were orally intubated (n=32) were enrolled; changes over time were assessed in 29 subjects who had data collected during the control day. The Pcuff was adjusted to a minimum of 22 cm H2O at the beginning of the shift, and monitoring was begun. Patient activities (e.g., turning, coughing, suctioning) were recorded by a research assistant on a tablet computer using software (Spectator GO! Biobserve, Bonn, Germany) that captures real-time data. RESULTS: Subjects were aged 62 +/- 20 years, male (n=25), and intubated for 4 +3 days. To compare the variation in pcuff during activity, a dataset consisting of repeated measures of variations during activities was compiled; data were compared using a generalized estimation equation method. Significant increases in variation of pcuff (p < .05) were noted with ETT suction, turning, movement, coughing, and procedures. Significant decreases were found after medication for pain or agitation. As a natural history model for pcuff, the change pattern over time (control day) was assessed. A linear model was fit by regressing pcuff on time for each patient; values decreased significantly over time (p< .0000). CONCLUSIONS: The pcuff was dynamic and changed frequently. Many activities increased pcuff; values quickly returned to baseline. Pcuff decreased after administration of medications, which may be related to a higher sedation level or physiological effects on the airway; clinical signs such as low exhaled volume alarm or audible leak were not often seen. Since the pcuff decreased over time, determining the optimum pressure to adjust the pcuff, and frequency of assessment to prevent complications, is needed.en_GB
dc.date.available2011-10-26T19:29:41Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:29:41Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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