Abstract will be available upon expiration of embargo

Chen, Ruo S.

LaBarge, Kara L.

O\u27Connor, Laurel C.

Rebesco, Matthew R.

Remotti, Edgar J.

Tennyson, Joseph C.

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Senior Scholars Program School of Medicine 2020-05-15 Prehospital Intubations Are Associated With Elevated Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at the UMMMC University Emergency Department Ruo S. Chen University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/ssp  Part of the Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Emergency Medicine Commons, and the Medical Education Commons Repository Citation Chen, Ruo S.; Rebesco, Matthew R.; O'Connor, Laurel C.; LaBarge, Kara L.; Remotti, Edgar J.; and Tennyson, Joseph C., "Prehospital Intubations Are Associated With Elevated Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at the UMMMC University Emergency Department" (2020). University of Massachusetts Medical School. Senior Scholars Program. Paper 281. https://escholarship.umassmed.edu/ssp/281 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Senior Scholars Program by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Senior Scholars Program AY 19/20                                                                                                                      Chen 1 Ruo Chen, Class of 2020 Department of Emergency Medicine, Division of Emergency Medical Service  Prehospital Intubations Are Associated With Elevated Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at the UMMMC University Emergency Department  Ruo S. Chen, BA1; Matthew R. Rebesco, MD1; Laurel C. O’Connor, MD1; Kara L. LaBarge, MD1; Edgar J. Remotti, BA1; Joseph C. Tennyson, MD1  1Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA  Background: Emergency medical services (EMS) providers are trained to place endotracheal tubes (ETT) in the field when indicated. ETT cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is relatively extensive 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. EMS providers in our system currently do not check ETT cuff pressures and UMass Memorial Medical Center (UMMMC) does not routinely record this data. We hypothesized that the average ETT cuff pressure of patients arriving at the UMMMC University Emergency Department (ED) who were intubated by EMS exceeds the safe pressure range.  Objectives: While ETT cuff inflation is necessary to close the 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 for ETTs placed by EMS providers in our system.  Methods: This project was a single center prospective observational study. ETT cuff pressures were measured and recorded for all adult patients intubated by EMS providers prior to arrival at a large urban tertiary care center. All measurements were performed by respiratory therapists utilizing the AG Cuffill device. Results including the patient demographics, cuff pressure, tube size, and EMS service were recorded.  Results: At this time, 38 out of the 44 cuff pressures needed to reach clinical significance have been collected and the results discussed here are preliminary. Two cuff pressures fall within the 20-30cmH2O range, 2 fall below 20cmH2O, and the remaining 34 are above 30cmH2O. Twenty-four of these are undetectably greater than 100cmH2O and since a specific pressure could not be determined we used 100 for calculations. The current mean cuff pressure is 83.2 cmH20. The median and mode cuff pressures are 100 cmH2O and 100 cmH2O, respectively.  Conclusion: Preliminary results indicate that our initial hypothesis is correct. Although final statistical analysis has not been completed, the overwhelming number of elevated cuff pressures point to the conclusion that prehospital intubations are associated with elevated cuff pressures which may be predisposing the patients to negative side effects.  

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

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1282&amp;context=ssp

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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