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Effect of body position changes on endotracheal tube cuff pressure in ventilated patients

Introduction

In order to avoid either microaspiration (<20 cmH2O) or tracheal injury (>30 cmH2O), the target for endotracheal tube (ETT) cuff pressure (CP) is between 20 and 30 cmH2O. Our objective was to assess the effect of patient positioning changes on CP in adult patients.

Methods

A sample of 12 orally intubated and sedated patients was selected. Patients received neuromuscular blockade and were positioned in a neutral start position (backrest, head of bed elevation (HoB) 30°, head in neutral position) and CP set at 25 cmH2O. Subsequently 16 different position changes were performed: anteflexion head, hyperextension head, left and right lateral flexion of head, left and right rotation of the head, semirecumbent position (HoB 45°), recumbent position (HoB 10°), horizontal position, trendelenburg (-10°), left and right lateral positioning over 30°, 45° and 90°. Once the patient was correctly positioned, CP was recorded during an end-expiratory ventilatory hold. CP observed was compared with CP at start position (25 cmH2O). Also the number of values outside the target range (20 to 30 cmH2O) was reported as considered clinically relevant.

Results

A total of 192 measurements were performed (12 subjects×16 positions). Results are shown in Table 1 (CP reported as median, IQR). In every position a significant deviation in CP was observed. In total, 40.6% of values exceeded the upper limit of 30 cmH2O. No values beneath the lower target limit of 20 cmH2O were observed. In each position the upper target limit was exceeded at least once.

Table 1 Endotracheal tube cuff pressure values following patient position changes

Conclusion

Simple changes in patient positioning may result in potentially harmful CP (>30 cmH2O). These observations call for strict CP monitoring.

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Correspondence to C Lizy.

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Lizy, C., Swinnen, W., Labeau, S. et al. Effect of body position changes on endotracheal tube cuff pressure in ventilated patients. Crit Care 17, P154 (2013). https://doi.org/10.1186/cc12092

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Keywords

  • Endotracheal Tube
  • Position Change
  • Neuromuscular Blockade
  • Start Position
  • Cuff Pressure