Prehospital Intubations Are Associated With Elevated Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at the UMMMC University Emergency Department

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Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

INTRODUCTION: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. OBJECTIVES: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. METHODS: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. RESULTS: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. CONCLUSION: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon

Diagnostic criteria using microfacies for calcareous contourites, turbidites and pelagites in the Eocene–Miocene slope succession, southern Cyprus

Interbedded contourites, turbidites and pelagites are commonplace in many deep-water slope environments. However, the distinction between these different facies remains a source of controversy. This detailed study of calcareous contourites and associated deep-marine facies from an Eocene–Miocene sedimentary succession on Cyprus clearly documents the diagnostic value of microfacies in this debate. In particular, the variability of archetypical bi-gradational contourite sequences and their internal subdivision (bedding, layering and lamination) are explored. Contourites can be distinguished from turbidites, pelagites and hemipelagites by means of carbonate microfacies in combination with bed-scale characteristics. Particle composition provides valuable information on sediment provenance. Depositional texture, determined by the ratio between carbonate mud and bioclasts, is crucial for identifying bi-gradational sequences in both muddy and sandy contourites, and normally-graded sequences in turbidite beds. Equally important are the type and preservation of traction structures, as well as the temporality and impact of bioturbation. Shell fragmentation under conditions of increased hydrodynamic agitation (textural inversion) is recognized as a carbonate-specific feature of bioclastic sandy contourites.Spanish Ciencia y Tecnologias Marinas projects CTM 2012-39599C03 CGL2016-80445-R CTM2016-75129-C3-1-RSecretaria de Estado de I+D+I, Spain CGL201566835-P PID2019-104625RB-100PFEDER Andalucía B-RNM-072-UGR18Junta de Andalucía P18-RT-4074Universidad de Granada UCE2016-05Projekt DEAL (University of Greifswald in the Alliance of German Science Organizations