Evaluating the Difference in Cuff Pressure With and Without the Use of a Stopcock

Abstract

Background:

Cuff pressure manometry is a standard of care in many health care facilities to ensure appropriate and safe cuff pressures of endotracheal and tracheostomy tubes. Anecdotal bedside experience using a commercially available product produced the thought that we were losing cuff pressure upon initial attachment to the pilot balloon. We sought to evaluate if there was a difference in cuff pressure loss with and without a stopcock attached to the syringe manometer.

Methods:

IRB approval was obtained for this quality improvement study of subjects that were intubated with an oral endotracheal tube or subjects who had a tracheostomy. Exclusion criteria included any patient that was under the age of 18, was using a speaking valve, was not on a ventilator, or had a non-air-filled cuff. Using the Mallinckrodt Puritan-Bennett PTS 2000 Ventilator Analyzer (TSI Incorporated, St. Paul, MN) cuff pressures were recorded. Cuff pressure was set without a stopcock, the manometer was removed, then placed back on the pilot balloon. The difference between the two pressures was the without stopcock pressure gradient. A stopcock was then attached to the manometer, the cuff was pressurized, and the stopcock was turned off to the cuff. The manometer was removed from the pilot balloon and then reattached; the stopcock was then opened to the balloon. The difference between the two pressures was the with stopcock pressure gradient. Data was analyzed using IBM SPSS software v25 (IBM, Armonk, New York) using Wilcoxon signed rank test.

Results:

20 evaluations were included in the study: 14 endotracheal tubes and 6 tracheostomies. There was significantly more pressure loss without a stopcock (median 5.49 cm H₂O) compared to the pressure loss with a stopcock attached (median 0.78 cm H₂O; P = .011).

Conclusions:

There is pressure loss when measuring cuff pressure with the commercial manometer. Utilizing a stopcock attached to the manometer and pre-pressurizing the manometer had less cuff pressure loss. While there is a significant difference, we are unsure of the clinical significance. Further studies could confirm our findings.