Endotracheal Cuff Pressure Changes During Helicopter Transport: A Systematic Review

Abstract

Objective: Cuff pressures are important in ventilated patients undergoing helicopter transport. An altitude-related increase in endotracheal tube (ETT) intracuff pressure has been shown in simulated hypobaric environments, model tracheas, and animal studies and may not accurately reflect in vivo pressures. The aim of this study was to determine if ETT intracuff pressure increases above the critical perfusion pressure of the trachea in ventilated patients during helicopter transport.

Methods: Ovid Medline, CINAHL, Embase, Scopus, and the Cochrane Library were searched from their commencement to January 29, 2016. Google Scholar was searched, and reference lists of relevant articles were examined to identify additional studies. Articles were included if they reported on ETT intracuff pressure in ventilated patients during helicopter emergency medical service transport.

Results: A total of 330 articles were identified; only 2 prospective observational studies met the inclusion criteria. The studies reported a mean cuff pressure increase of 23 cm H₂O and 33.9 cm H₂O. Both studies reported ETT intracuff pressure to frequently exceed the critical perfusion pressure of the tracheal mucosa during helicopter transport.

Conclusion: Further research with longitudinal follow-up is required to confirm these findings to determine if the effects of transient increased ETT intracuff pressure are clinically significant.