endotracheal tube cuff pressure complications

Dartevelle P, Macchiarini P. Management of acquired tracheoesophageal fistula. ), When the decision is made to proceed with exchanging the ETT, selecting a different size, length, and type of ETT should be individualized and decided in advance. Nseir S, Di Pompeo C, Pronnier P, et al. Results: An improvement in knowledge was observed on the nursing care practices for the management of endotracheal tube cuff pressure for both groups following the educational intervention . Intensive Care Med. Prevalence and risk factors for nosocomial lower respiratory tract infections in German hospitals. In support of this approach, one trial randomly assigned 58 patients with VAT to receive intravenous antibiotics or placebo for eight days [77]. Hence there is challenging to maintain the cuff pressure within an optimal range. It generally resolves spontaneously but speech therapy may be required when dysphonia is profound or associated with vocal paralysis. Endotracheal tube cuff pressure monitoring is an integral component of ICU (Intensive Care Unit) care. Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Complications of UE include aspiration, respiratory distress, laryngeal edema, and death. Long term complications can occur with both of these modes of intubation and include all of the conditions described in this topic. Occasionally, individual adjustment within these parameters is needed. Shinn JR, Kimura KS, Campbell BR, et al. This study aimed to determine the ETT cuff pressure and appropriate intervals for . Bottom: The HPLV cuff on the endotracheal tube used with the LMA Fastrach (LMA North . (See "Approach to the anatomically difficult airway in adults outside the operating room" and "Video laryngoscopes and optical stylets for airway management for anesthesia in adults" and 'Exchanging the endotracheal tube' below. VAT was associated with a longer duration of mechanical ventilation (24 versus 9 days) and an increased length of ICU stay (32 versus 13 days) when compared to cases without VAT [74]; a nonsignificant increase in mortality was also reported (36 versus 32). Intensive Care Unit (ICU) patients may have not the capacity to spontaneous breathing and require mechanical ventilation. Evidence of ETT migration on physical examination should prompt chest radiography and repositioning when necessary, the details of which are discussed below. Spiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings. Anesth Analg 2015; 121:440. The first published method is based on the width of the nasal septum of the dog's nose being equal to the . One prospective cohort study of 100 consecutive patients who underwent endoscopic examination after extubation reported that 57 percent of patients had signs of acute laryngeal injury as evidenced by the presence of ulceration or granulation tissue [29]. Daily care includes monitoring ETT cuff pressure, oral and endotracheal suctioning of secretions, and vigilant inspection to ensure that the ETT is rotated regularly and its position maintained. There may be a trend towards higher risk of airway injury in patients with diabetes, hypertension, heart failure, kidney, and malnutrition [34,35]. ), ●ETT cuff leaks (ie, the recorded expired volume is lower than the set tidal volume) can be due to a defective cuff/inflation system or to a leak around the cuff. Adair CG, Gorman SP, Feron BM, et al. NASAL INTUBATION AND TRACHEOSTOMY — Although nasal intubation is typically temporary, occasionally they are placed for prolonged periods. Repositioning the ETT should be performed by deflating the cuff and moving the ETT for a preselected distance that is estimated to place the ETT back to an appropriate position (eg 21 cm at the lip); the level at the lip is recorded, the cuff is reinflated, and the new position checked on chest radiography. Pneumatikos I, Konstantonis D, Tsagaris I, et al. Suzuki N, Kooguchi K, Mizobe T, Hirose M, Takano Y, Tanaka Y. PLoS One. Each case is followed by a series of board-style question and answers. The book reveals how experienced clinicians use critical thinking in their clinical decision making. Anand VK, Alemar G, Warren ET. Bonferroni correction test shows that average of endotracheal tube cuff pressure in all six groups are significantly different from constant group (P = 0.000). Preceded by: AACN procedure manual for critical care / edited by Debra Lynn-McHale Wiegand. 6th ed. c2011. Multidrug resistant bacteria, polymicrobial infections, and viral organisms including herpes simplex can also be pathogenic [75,79]. All patients with nosocomial sinusitis should be assessed for concurrent VAP. Laryngoscope 2001; 111:1333. Influence of level of consciousness with implications for therapy. Crit Care Med 2006; 34:2766. ●Leaks around an intact cuff/inflation system ─ Leaks around an intact cuff/inflation system are caused by cuff under-inflation, cephalad migration of the ETT, tracheal misplacement of oro/nasogastric tubes, discrepancy between ETT and tracheal diameter (occasionally the balloon will "soften" over time, or some patients have tracheomalacia), and high peak airway pressures. complications of endotracheal tube - dislogement - aspiration - airway trauma/necrosis (cuff pressure high) - obstruction - loss of cough seal - retained secretions - bacterial colonization -> infection - endo sinusitis. In: StatPearls [Internet]. Similar to tracheal stenosis, it occurs weeks to months after the initial intubation. Stauffer JL, Olson DE, Petty TL. Talmor M, Li P, Barie PS. Surgical repair is a complicated procedure that uses a cervicotomy or cervicosternotomy approach to obtain esophageal closure and tracheal resection or reconstruction. Laryngeal injury — Laryngeal injury encompasses several disorders including laryngeal inflammation and edema as well as vocal cord ulceration, granulomas, paralysis, and stenosis. Endoscopic intervention with a combination of esophageal and/or tracheal stenting has been used for palliation and for transient medical management [110]. Overinflation of an endotracheal tube (ETT) cuff can lead to severe complications, including tracheal necrosis, laryngeal nerve palsy, and tracheo . Vocal fold injury following endotracheal intubation. Anesth Analg 2013; 117:428. Saudi J Anaesth. Nosocomial sinusitis in patients in the medical intensive care unit: a prospective epidemiological study. Braz J Otorhinolaryngol 2016. (See "Approach to the anatomically difficult airway in adults outside the operating room". The cause of impaired swallowing following extubation is not well understood, but it usually resolves without intervention [98]. how should endotracheal tube be placed. Tracheoesophageal fistula. ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Kristy Bauman, MD, who contributed to an earlier version of this topic review. The effect of body mass index on intubation success rates and complications during emergency airway management. The optimal frequency of suctioning depends on the quantity of secretions. Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity. (See "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Subglottic drainage' and "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Silver-coated endotracheal tube' and "Weaning from mechanical ventilation: Readiness testing".). J, Wadhwa A. Endotracheal tube cuff pressure in three hospi-tals, and the volume required to produce an appropriate cuff pressure. This leads to necrosis, destruction of the tracheal architecture, and scarring. Harley HR. Ann Otol Rhinol Laryngol 1981; 90:469. The management of VAT is virtually identical to the management of VAP. This manual is aimed at all healthcare practitioners, from novice to expert, who care for the critically ill patient, recognising that different disciplines contribute to the provision of effective care and that essential knowledge and ... Practicing paramedics cannot generate or estimate safe endotracheal tube cuff pressure using standard techniques. Please enable it to take advantage of the complete set of features! Cuff pressure is measured and adjusted intermittently. There are two types of tracheal tube cuff pressure techniques. Kikura M, Suzuki K, Itagaki T, et al. Invasive ventilation is a common treatment in intensive care . Prehosp Emerg Care . Most experts perform the exchange using medications similar to those for intubation. Heart Lung 1994; 23:59. Sue RD, Susanto I. Aneroid manometers for measurement of ETTcP are not widely available in Ghana, hence anaesthesia providers estimate ETTcP according to their experience. ●The position of the ETT at the level of the lip should be formally checked by healthcare staff during daily routine assessments as well as following periods of care that are high risk for ETT displacement (eg, turning and transport). Zhonghua Yi Xue Za Zhi (Taipei) 1992;49:348–53. Figure 1. Gastroesophageal reflux in patients with subglottic stenosis. When the ETT cuff pressure exceeds the mean capillary pressure in the tracheal mucosa (approximately 20 cm H2O), obstruction of capillary blood flow causes ischemia, inflammation, and erosion of the mucosa. Direct visualization of the vocal cords is typically required for diagnosis (usually laryngoscopy or bronchoscopy) and should be prompted when symptoms don't resolve following extubation or in those in whom a suspected condition is responsible for extubation failure, or failure to wean from mechanical ventilation. Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure. Conservative care is indicated until the patient is stable enough to undergo surgical correction (may take weeks to months). (See 'Tracheomalacia' above and 'Tracheoarterial fistula' above and 'Tracheoesophageal fistula' above. Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation. 8600 Rockville Pike Scarless remote access endoscopic and robotic thyroidectomy has been recently performed as a safe and feasible method. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. ETT cuffs are categorized as being high volume, low pressure (HVLP) cuffs or low volume, low pressure (LVLP) cuffs. Thorax 1972; 27:338. Once confirmed, the ETT can be moved distally. Nosocomial sinusitis. Laryngeal injuries secondary to nasogastric tubes. When the ETT needs to be changed, experienced providers including an advanced airway team should be consulted prior to ETT replacement. ([FOOTNOTE=Liu J, Zhang X, Gong W. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Curr Opin Otolaryngol Head Neck Surg 2016; 24:510. Nseir S, Di Pompeo C, Soubrier S, et al. This handbook provides students, residents, fellows, and practicing physicians with a clear explanation of essential physiology, terms and acronyms, and ventilator modes and breath types. The clinical consequences vary from trivial to emergent respiratory compromise depending upon patient characteristics and the degree of leak. Designated a Doody's Core Title! "This is a valuable resource for readers seeking basic to advanced information on measurement. It should be on the bookshelf of all researchers, and a requirement for graduate nursing students. Clinical manifestations — Most patients with laryngeal injury manifest as hoarseness/dysphonia immediately following extubation. However, they may be preferred in those where tape is not desirable (eg, allergy, burns). It is generally caused by compression (typically from the cuff) of the anterior branch of the recurrent laryngeal nerve between the ETT cuff and the thyroid cartilage in the subglottic larynx (ie, neurogenic vocal cord paralysis); however rare cases may be due to arytenoid dislocation, possibly from forceful intubation [44,46-48]. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. By continuing to browse this site you are agreeing to our use of cookies. Evidence supporting specific strategies regarding the management of ETT-associated infections is best described for VAP but similar principles are used for managing VAT and sinusitis. Sign up today to receive the latest news and updates from UpToDate. complications of endotracheal tube - dislogement - aspiration - airway trauma/necrosis (cuff pressure high) - obstruction - loss of cough seal - retained secretions - bacterial colonization -> infection - endo sinusitis. ), ●Additional uncommon complications include tracheomalacia and tracheoarterial and tracheoesophageal fistula formation. Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Unless the ETT is suspected to be in the oropharynx, chest radiography should be immediately performed. Infections — Bacteria enmeshed in a biofilm can adhere to the inner surface of the ETT within hours of intubation which may contribute to both ventilator-associated pneumonia (VAP [ie, infection-related ventilator associated complication; iVAC]) and ventilator-associated tracheobronchitis (VAT) [14,68-71]. JAMA 2017; 317:483. 27,30 (See "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Decontamination of the oropharynx and digestive tract'.). Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Darmon JY, Rauss A, Dreyfuss D, et al. (See 'Laryngeal injury' below and 'Endotracheal cuff leaks' below.). how should endotracheal tube be placed. The high-pressure low-volume (HPLV) cuff has a small diameter at rest, and for sealing in the trachea, it requires a high intra-cuff pressure to overcome the low compliance of the cuff itself. There is no convincing evidence that ETT holding devices lower the rate of displacement or pressure ulceration, further details of which are discussed below. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. Tracheal perfusion pressure, estimated to be 22 mm Hg to 30 mm Hg, must not be exceeded by the ETT cuff pressure (Khan et al., 2016). Occasionally, when a cause for a substantial air leak cannot be determined, many clinicians opt to replace the ETT. VAT may be an intermediate condition between lower respiratory tract colonization and VAP (ie, iVAC). The ETT can also impair sinus drainage leading to an increased risk of sinusitis. Reflecting this practice, the proportion of mechanically ventilated patients receiving daily chest radiographs in the United States has steadily declined from 2008 to 2014 [28]. Disclaimer, National Library of Medicine Crit Care 2011; 15:R19. This text provides key knowledge in a concise and accessible manner for trainees, clinicians and consultants from specialities and disciplines such as cardiology and anaesthesia, and nursing and physiotherapy. This is generally done manually with a Yankauer oral suction catheter. Special caution is necessary when a patient is transported to a different altitude. If the cuff/inflation system is intact, the ETT may need an adjustment (eg, ETT repositioning, increased cuff volume, reducing peak pressures); the ETT typically does not have to be replaced with a new tube, unless a larger ETT is needed. The critical care unit manages patients with a vast range of disease and injuries affecting every organ system. The unit can initially be a daunting environment, with complex monitoring equipment producing large volumes of clinical data. Does endo-tracheal tube clamping prevent air leaks and maintain positive end-expiratory pressure during the switching of a ventilator in a patient in an intensive care unit? Kampf G, Wischnewski N, Schulgen G, et al. High cuff pressures have been reported to directly cause airway complications; epithelial necrosis (with fistula formation), tracheomalacia, laryngeal inflammation, and stenosis. Am J Infect Control 2008; 36:309. The association of hypotension and high intra tracheal tube cuff pressure could be the chief Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. The cuff pressure gauge is used for inflation, deflation and pressure control includes. J Am Coll Radiol 2021; 18:S62. Al-Metwalli RR, Al-Ghamdi AA, Mowafi HA, Sadek S, Abdulshafi M, Mousa WF. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. : [1102 - 104.224.13.98 - BC27E3B037 - PR14 - UPT - 20211029-16:19:56GMT], Approach to the anatomically difficult airway in adults outside the operating room, Assessment of respiratory distress in the mechanically ventilated patient, Clinical presentation and diagnostic evaluation of ventilator-associated pneumonia, Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults, Complications of airway management in adults, Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults, Direct laryngoscopy and endotracheal intubation in adults, Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired and ventilator-associated pneumonia in adults, Extubation management in the adult intensive care unit, Flexible bronchoscopy balloon dilation for nonmalignant airway strictures (bronchoplasty), Induction agents for rapid sequence intubation in adults outside the operating room, Management and prognosis of patients requiring prolonged mechanical ventilation, Neuromuscular blocking agents (NMBAs) for rapid sequence intubation in adults outside of the operating room, Nutrition support in critically ill patients: An overview, Oropharyngeal dysphagia: Clinical features, diagnosis, and management, Overview of pulmonary function testing in adults, Physiologic and pathophysiologic consequences of mechanical ventilation, Rapid sequence intubation for adults outside the operating room, Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults, Supraglottic devices (including laryngeal mask airways) for airway management for anesthesia in adults, Tracheomalacia and tracheobronchomalacia in adults, Treatment of hospital-acquired and ventilator-associated pneumonia in adults, Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment, Video laryngoscopes and optical stylets for airway management for anesthesia in adults, Weaning from mechanical ventilation: Readiness testing, "Direct laryngoscopy and endotracheal intubation in adults", "Rapid sequence intubation for adults outside the operating room", "Induction agents for rapid sequence intubation in adults outside the operating room", "Neuromuscular blocking agents (NMBAs) for rapid sequence intubation in adults outside of the operating room", "Supraglottic devices (including laryngeal mask airways) for airway management for anesthesia in adults", "Approach to the anatomically difficult airway in adults outside the operating room", "Video laryngoscopes and optical stylets for airway management for anesthesia in adults", "Complications of airway management in adults", "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Subglottic drainage', "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Decontamination of the oropharynx and digestive tract', "Diagnosis, management, and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults", "Physiologic and pathophysiologic consequences of mechanical ventilation", "Management and prognosis of patients requiring prolonged mechanical ventilation", section on 'Weaning', "Extubation management in the adult intensive care unit", section on 'Cuff leak', "Direct laryngoscopy and endotracheal intubation in adults", section on 'Complications', "Extubation management in the adult intensive care unit", section on 'Glucocorticoids', "Overview of pulmonary function testing in adults", "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults", "Flexible bronchoscopy balloon dilation for nonmalignant airway strictures (bronchoplasty)", "Assessment of respiratory distress in the mechanically ventilated patient", "Extubation management in the adult intensive care unit", section on 'Patients with unplanned extubation', "Treatment of hospital-acquired and ventilator-associated pneumonia in adults", "Clinical presentation and diagnostic evaluation of ventilator-associated pneumonia", "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", "Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired and ventilator-associated pneumonia in adults", "Epidemiology, pathogenesis, microbiology, and diagnosis of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Microbiology', "Treatment of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Empiric therapy', "Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment", section on 'Symptomatic management', "Oropharyngeal dysphagia: Clinical features, diagnosis, and management", "Extubation management in the adult intensive care unit", section on 'Refeeding', "Tracheomalacia and tracheobronchomalacia in adults", "Nutrition support in critically ill patients: An overview", "Flexible scope intubation for anesthesia", section on 'Nasal intubation', "Direct laryngoscopy and endotracheal intubation in adults", section on 'Nasal intubation using direct laryngoscopy', 'Presentation and management of complications in the ICU', "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Silver-coated endotracheal tube', "Weaning from mechanical ventilation: Readiness testing". Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J. Sore throat after endotracheal intubation. Keywords: Multiple complications associated with high cuff pressures have been reported3-7, including tracheal mucosal ischaemia, mucosal inflammation, stridor . The minimal occlusion cuff pressure required for positive pressure ventilation, to prevent aspiration, is approximately 27 cm H20. Intensive Care Med 1999; 25:1037. Presenting signs and symptoms may occur when the ETT or tracheostomy is in place or following extubation or decannulation. 2012 Feb;21(4):513-9. PREVENTION OF COMPLICATIONS IN THE ICU — Daily endotracheal tube care should be provided to avoid complications associated with ETTs. Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. The ETT should also be rotated from side to side daily to avoid pressure-induced ulceration at the lip, face, and cheek; however, the constant re-taping can weaken the stability of the ETT and can also result in skin tears in those with fragile skin. New to this edition are chapters covering anesthesia considerations for specific conditions and diseases, including perioperative blood works and urine analysis blood transfusion medicine anesthetic considerations and interpretations ... We and other experts believe that clear identification of this group (eg, color-coded signs in the room) is prudent since it alerts care givers to being extra vigilant regarding ETT safety and prompt rapid consultation of an expert in difficult airway management in the event that it is needed for an ETT-related complication, thereby avoiding multiple failed attempts at reintubation. The known complications of high endotracheal tube cuff pressure can be avoided if the cuff pressure controller device is used and manual methods cannot be relied upon for keeping the pressure within the recommended levels. (See 'Swallowing and speech impairment' above. Further details are described separately. 2016 Jul 14;11(7):e0158137. In: Clinical Procedures in Emergency Medicine, 3rd ed, WB Saunders Company, Philadelphia 1998. p.23. (See "Treatment of hospital-acquired and ventilator-associated pneumonia in adults", section on 'Empiric therapy'. A full chapter is dedicated to every common surgical ENT procedure, as well as less common procedures such as face transplantation. Clinical chapters are enriched with case descriptions, making the text applicable to everyday practice. 2005; Saulez et al. The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study Hakan Kara, Dilek Hundur, Can Doruk, Dilan Buyuk, Gul Cansever, Emine Aysu Salviz , Emre Camci As an example, in a prospective cohort of 1889 intubated patients, VAT developed in 11 percent of patients. Otolaryngol Clin North Am 2004; 37:25. The rationale for this approach is based upon the avoidance of a third attempt at reintubation if the displacement was originally due to a significant cuff leak/rupture (ie, a mechanical fault with the ETT). For example a small leak (eg, 25 mL) may not be tolerated well in a patient with severe acute respiratory distress syndrome on high ventilatory pressures and high fraction of inspired oxygen, while larger volumes may be tolerated in patients with normal underlying lung function who are intubated for airway protection. Intubation techniques, checking ETT position after initial placement, and immediate complications of ETT as well as complications associated with placement of supraglottic airway devices are discussed separately. A bench study. (See "Tracheomalacia and tracheobronchomalacia in adults". Cuaño PMGM, Pilapil JCA, Larrazabal RJB, Villalobos RE. This article reviews the possible complications associated with the ETT cuff, and the landmark development made in that field. Textbook of Anaesthesia has become the book of choice for trainee anaesthetists beginning their career in the specialty. It is highly suitable for part 1 of the Fellowship of the Royal College of Anaesthetists and similar examinations. A Comparison of the Haider Tube-Guard® Endotracheal Tube Holder Versus Adhesive Tape to Determine if This Novel Device Can Reduce Endotracheal Tube Movement and Prevent Unplanned Extubation. Quantitative culture of sinus fluid identifies a likely pathogen in 60 to 70 percent of patients who are strongly suspected of having nosocomial sinusitis (ie, have fever without an alternative cause, sinus opacification on CT, purulent nasal drainage) [82,89,90]. 2014 Jun;124(6):1415-9. doi: 10.1002/lary.24481. However, vocal cord paralysis due to dislocation of the cricoarytenoid joint, can be distinguished from neurogenic paralysis by joint palpation and/or imaging [45]. Intensive Care Med 2010; 36:991. Rello J, Soñora R, Jubert P, et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sariego J. Salord F, Gaussorgues P, Marti-Flich J, et al. Now new chapters, new authors, meticulous updates, an increased international presence, and a new full-color design ensure that the 7th edition continues the tradition of excellence that you depend on. Russotto V, Myatra SN, Laffey JG, et al. Traumatic intubation may be related to abnormal laryngeal anatomy, difficult laryngoscopy, multiple attempts, or operator inexperience. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. From a practical perspective VAT is a hard diagnosis to make since many patients intubated in the ICU have abnormal radiographs and positive sputum cultures and it is frequently challenging to effectively rule out all the potential causes for fever. View videos of intubation and airway management procedures online at www.expertconsult.com, plus access the entire, searchable contents of the book. Introduction. Clinical Practice Manual for Pulmonary and Critical Care Medicine, by Judd W. Landsberg, MD, is a unique point-of-care manual that provides essential information on managing inpatients and outpatients with common, serious respiratory and ... J Laryngol Otol 2005; 119:825. Introduction This review describes factors influencing endotracheal tube cuff pressure measurement; there are many factors affect the ETT cuff pressure in form of patient-related factors, environmental circumstances, and therapeutic interventions. Bethesda, MD 20894, Help PMC If this goes unnoticed, the lack of oxygen to the body could result in brain damage, cardiac arrest, or death. JAMA 2021; 325:1164. Previous studies have suggested . J Surg Educ 2007; 64:237. The ETT is one risk factor among others for VAP. Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation.