Artificial airways: a survey of cuff management practices

Abstract

Objective: To determine current endotracheal and tracheostomy tube cuff management practices in adult and pediatric populations, and to compare current adult cuff management practice with those reported in use in 1984 and 1987.

Design: Descriptive survey.

Setting: Sixty-four acute care hospitals in the northeastern United States.

Sample: Responders represented 93 critical care units: 59 adult and 34 pediatric units.

Measurements: Subjects completed a survey questionnaire.

Results: Forty-one percent reported cuffs were routinely deflated, with most (88%) reporting cuff deflation every 8 to 12 hours or daily. In the pediatric population, minimal occlusive volume was the most frequent technique (29%); whereas in the adult population, both minimal occlusive volume technique and minimal leak technique were used more frequently (36%). Most (93%) cuff pressures were measured every 8 to 12 hours or daily with a recommended maximum range of 20 to 30 mm Hg. Cuff deflation and cuff inflation were performed more often by the nursing staff (36%). Cuff pressures were performed more often by respiratory staff (71%). There were no statistically significant differences in the cuff management practices between the adult and pediatric populations. In comparing the results for adults to the data of 1984 and 1987, most cuff management practices changed from every 8 hours or less to every 8 to 12 hours or daily, and the nursing responsibility for these techniques increased (22%).

Conclusion: Most responders do not routinely deflate cuffs. Cuff management practices are performed less frequently, and nursing responsibility for these techniques has increased.