Endotracheal cuff pressure monitoring: another alarm in the ICU?

摘要

I read with interest the article by Sole and colleagues on continuous monitoring of cuff pressure. The authors evaluated the impact of an intervention to reduce underinflation and overinflation of tracheal cuffs in intensive care unit (ICU) patients. During the intervention period, cuff pressure was continuously monitored and an alarm was used to inform nurses that cuff pressure was out of range (20-30 cm H_2O) in order to adjust it. The intervention was successful because the percentage of cuff pressure values out of range was significantly reduced during the intervention period compared with the control period (11.1% vs 57.1%, p <0.001). However, an alarm sounded 7 to 190 times/day/patient during the intervention period (mean 35, SD, 35). The authors stated that most of these alarms did not require intervention and were transient high-pressure alarms associated with coughing, suction, turning, and agitation. Adjustment of cuff pressure was only performed if a low alarm (<20 cm H_2O) was sustained for more than 15 seconds, or a high alarm (>30 cm H_2O) was sustained for more than 15 minutes. Surprisingly, the number of intervention was small mean +-SD 8+-3 (range 2-14 per patient).