Comparative Evaluation of the Usability of Two Endotracheal Cuff Pressure Measuring Devices in Mechanically Ventilated Patients: A Prospective Randomized Cohort Study
Authors
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Objective: compare a disposable cuff pressure device with a traditional analogue manometer in terms of ease of use, time efficiency, and user preference. Design: prospective randomised cohort study. Subjects/Patients: Intensive care unit patients >18 years, intubated on mechanical ventilation. Methods: 121 patients, randomly allocated into two groups for measurement of cuff pressure by device A and B respectively; by trained operators. Time to measurement and ease-of-use scores (5-point Likert scale) were recorded. User preference was assessed using McNemar’s test. Missed opportunities to measure cuff pressure were documented. Proportional differences in missed measurements were analyzed using a z-test. Results: Device B showed significantly faster measurement time (38.6 ± 5 seconds) compared to Device A (49.2 ± 8 seconds). Ease-of-use scores were higher for Device B (4.2 ± 0.5) than Device A (3.5 ± 0.3). 27 users preferred Device B, while 6 preferred Device A (p < 0.001). Missed cuff pressure measurements were fewer with Device B (36/1289; 2.79%) compared to Device A (71/1276; 5.56%), with a statistically significant difference (z = 3.48, p < 0.001). Conclusion: Disposable device B definitely demonstrated superior usability, efficiency, and user preference compared to the routine analogue device. Its adoption may enhance adherence to cuff pressure monitoring protocols and improve safety standards.
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2025 Dr Amruta Datye, DNB (Anaesthesia) IDCCM, Dr Rohit Chadha, MD (Med) FICM
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Dr Amruta Datye, DNB (Anaesthesia) IDCCM, Sevasadan Lifeline Superspeciality Hospital (SSLSH), Miraj, Maharashtra, India.
Sevasadan Lifeline Superspeciality Hospital (SSLSH), Miraj, Maharashtra, India.
Dr Rohit Chadha, MD (Med) FICM, Sevasadan Lifeline Superspeciality Hospital (SSLSH), Miraj, Maharashtra, India.
Sevasadan Lifeline Superspeciality Hospital (SSLSH), Miraj, Maharashtra, India.
[1] Galinski M, Tréoux V, Garrigue B, Lapostolle F, Borron SW, Adnet F. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann Emerg Med. 2006 Jun;47(6):545-7. doi: 10.1016/j.annemergmed.2005.08.012. Epub 2005 Oct 17. PMID: 16713783.
[2] Bernon JK, McGuire CI, Carrara H, Lubbe DE. Endotracheal tube cuff pressures - the worrying reality: a comparative audit of intra-operative versus emergency intubations. S Afr Med J. 2013;103(9):641–3. doi: 10.7196/samj.6638.
[3] Liu J, Zhang X, Gong W, Li S, Wang F, Fu S, Zhang M, Hang Y. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg. 2010 Nov;111(5):1133-7. doi: 10.1213/ANE.0b013e3181f2ecc7. Epub 2010 Aug 24. PMID: 20736432.
[4] Rahmani F, Soleimanpour H, Zeynali A, Mahmoodpoor A, Shahsavari Nia K, Rahimi Panahi J, Sanaei S, Soleimanpour M, Mehdizadeh Esfanjani R. Comparison of tracheal tube cuff pressure with two techniques: fixed volume versus pilot balloon palpation. J Cardiovasc Thorac Res. 2017;9(4):196-199. doi: 10.15171/jcvtr.2017.34. Epub 2017 Oct 13. PMID: 29391932; PMCID: PMC5787331.
[5] Ozer AB, Demirel I, Gunduz G, Erhan OL. Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure. Niger J Clin Pract. 2013;16(2):253–7. doi: 10.4103/1119-3077.110139.
[6] Sadovyi V, Kuchyn I, Bielka K, Horoshko V, Sazhyn D, Sokolova L. Endotracheal tube cuff pressure assessment: expectations versus reality. Anaesthesiol Intensive Ther. 2024;56(4):241-245. doi: 10.5114/ait.2024.145411. PMID: 39917970; PMCID: PMC11736906.
[7] Duguet A, D’Amico L, Biondi G, Prodanovic H, Gonzalez- Bermejo J, Similowski T. Control of tracheal cuff pressure: a pilot study using a pneumatic device. Intensive Care Med. 2007;33:128-132
[8] Michikoshi, J., Matsumoto, S., Miyawaki, H. et al. Performance comparison of a new automated cuff pressure controller with currently available devices in both basic research and clinical settings. j intensive care 4, 4 (2016). doi 10.1186/s40560-016-0126-7
[9] Rose L, Redl L. Survey of cuff management practices in intensive care units in Australia and New Zealand. Am J Crit Care 2008:17(5):428-435.
[10] Jordan P, Rooyen D., Venter D. Endotracheal tube cuff pressure management in adult critical care units. S Afr J Crit Care 2012;28(1):13-16
[11] Klonner ME, Mattaliano G, Casoria V, Vogl C, Braun C. Disposable Airway Pressure Manometers for Endotracheal Tube Cuff Inflation. Animals (Basel). 2023 Jan 30;13(3):475. doi: 10.3390/ani13030475. PMID: 36766364; PMCID: PMC9913048.
[12] Das S, Kumar P, Comparison of minimal leak test and manual cuff pressure measurement technique method for inflating the endotracheal tube cuff. Indian J Clin Anaesth 2015;2(2):78-81
[13] Sanaie S, Rahmani F, Chokhachian S, Mahmoodpoor A, Rahimi Panahi J, Mehdizadeh Esfanjani R, Mirzaei M, Soleimanpour H. Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques. J Cardiovasc Thorac Res. 2019;11(1):48-52. doi: 10.15171/jcvtr.2019.08. Epub 2019 Mar 13. PMID: 31024672; PMCID: PMC6477115.
[14] Nseir S, Duguet A, Copin MC, De Jonckheere J, Zhang M, Similowski T. et al. Continuous control of endotracheal cuff pressure and tracheal wall damage: a randomized controlled animal study. Crit Care. 2007;11(5):R109. doi: 10.1186/cc6142.
[15] Harm F, Zuercher M, Bassi M, Ummenhofer W. Prospective observational study on tracheal tube cuff pressures in emergency patients--is neglecting the problem the problem? Scand J Trauma Resusc Emerg Med. 2013;21:83. doi: 10.1186/1757-7241-21-83.
[16] Stewart SL, Secrest JA, Norwood BR, Zachary R. A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement. AANA J. 2003;71(6):443–7.
[17] Sole ML, Penoyer DA, Su X, Jimenez E, Kalita SJ, Poalillo E, et al. Assessment of endotracheal cuff pressure by continuous monitoring: a pilot study. Am J Crit Care. 2009;18(2):133–43. doi: 10.4037/ajcc2009441
[18] Sole ML, Su X, Talbert S, Penoyer DA, Kalita S, Jimenez E, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. AJCC. 2011;20(2):109–18. doi: 10.4037/ajcc2011661.
[19] Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med. 2007;35(6):1543–9. doi: 10.1097/01.CCM.0000266686.95843.7D.
[20] Lorente L, Lecuona M, Jiménez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protect against ventilator-associated pneumonia. Critical Care. 2014;18(2):R77. doi: 10.1186/cc13837.
[21] Sengupta P, Sessler DI, Maglinger P, Wells’ S, Vogt A, Durrani J. et al. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol. 2004;4:8. doi: 10.1186/1471-2253-4-8.
[22] Stevens GJ, Warfel JW, Aden JK, Blackwell SD. Intraoperative Endotracheal Cuff Pressure Study: How Education and Availability of Manometers Help Guide Safer Pressures. Mil Med. 2018 Sep 1;183(9-10):e416-e419. doi: 10.1093/milmed/usx127. PMID: 29447402.
[23] Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel). 2023 Jan 20;12(2):227. doi: 10.3390/antibiotics12020227. PMID: 36830138; PMCID: PMC9952750.
[24] Gonzalez I, Dominguez CB, Di Salvo E, Loustau MP, Acevedo VS, Celano MD, Melero JC, Bianchini FJ, Gutierrez FJ, Mariani J, Murias G, Plotnikow GA. Behavior of Endotracheal Tube Cuff Pressure During a Routine Control Maneuver With Different Manometers. Respir Care. 2023 Oct;68(10):1400-1405. doi: 10.4187/respcare.10865. Epub 2023 May 23. PMID: 37221082; PMCID: PMC10506646.
[25] Kumar CM, Seet E, Van Zundert TCRV. Measuring endotracheal tube intracuff pressure: no room for complacency. J Clin Monit Comput. 2021 Feb;35(1):3-10. doi: 10.1007/s10877-020-00501-2. Epub 2020 Mar 20. PMID: 32198671; PMCID: PMC7223496.
[26] Coppadoro A, Bellani G, Foti G. Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review. Respir Care. 2019 Dec;64(12):1586-1595. doi: 10.4187/respcare.07127. Epub 2019 Sep 24. PMID: 31551284.
[27] Tafur LA, Lema-Florez E, Zorrilla-Vaca A. Can we regulate endotracheal tube cuff pressure using an anaesthetic machine? Anaesthesiol Intensive Ther. 2019;51(1):74-76. doi: 10.5603/AIT.a2019.0008. PMID: 31280555.
[28] Sevdi MS, Demirgan S, Erkalp K, Akyol O, Ozcan FG, Guneyli HC, Tunali MC, Selcan A. Continuous Endotracheal Tube Cuff Pressure Control Decreases Incidence of Ventilator-Associated Pneumonia in Patients with Traumatic Brain Injury. J Invest Surg. 2022 Mar;35(3):525-530. doi: 10.1080/08941939.2021.1881190. Epub 2021 Feb 14. PMID: 33583304.
[29] Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS, Yerra A, Chirla D. Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med. 2021 Feb;25(2):181-184. doi: 10.5005/jp-journals-10071-23737. PMID: 33707897; PMCID: PMC7922465.
[30] Khan MU, Khokar R, Qureshi S, Al Zahrani T, Aqil M, Shiraz M. Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method. Saudi J Anaesth. 2016 Oct-Dec;10(4):428-431. doi: 10.4103/1658-354X.179113. PMID: 27833487; PMCID: PMC5044728.
[31] Park JH, Lee HJ, Lee SH, Kim JS. Changes in tapered endotracheal tube cuff pressure after changing position to hyperextension of neck: A randomized clinical trial. Medicine (Baltimore). 2021 Jul 23;100(29):e26633. doi: 10.1097/MD.0000000000026633. PMID: 34398020; PMCID: PMC8294867.
[32] Sripadungkul D, Tanasoontornsut N, Wittayapairoch P, Ruenhunsa T, Sangsungnern P, Kasemsiri C, Maneewan N, Boonkamjad S. The evaluation of endotracheal tube cuff pressure in pediatric patients by subjective inflation techniques: a prospective observational study. BMC Anesthesiol. 2024 Nov 5;24(1):399. doi: 10.1186/s12871-024-02780-7. PMID: 39501142; PMCID: PMC11536933.
[33] Jain MK, Tripathi CB. Endotracheal tube cuff pressure monitoring during neurosurgery - Manual vs. automatic method. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):358-61. doi: 10.4103/0970-9185.83682. PMID: 21897508; PMCID: PMC3161462.
[34] Shelly WM, Dawson RB, May IA. Cuffed tubes as a cause of tracheal stenosis. J Thorac Cardiovasc Surg. 1969 May;57(5):623-7. PMID: 5787886.
[35] Bernhard WN, Cottrell JE, Sivakumaran C, Patel K, Yost L, Turndorf H. Adjustment of intracuff pressure to prevent aspiration. Anesthesiology. 1979 Apr;50(4):363-6. doi: 10.1097/00000542-197904000-00018. PMID: 434545.
[36] Johny P, Segaran S, Vidya MV, Zachariah M, Koshy SG. A Comparative Study of Cuff Pressure Changes of Endotracheal Tube with the Use of Air Versus Nitrous Oxide in the Anaesthetic Gas Mixture During Laparoscopic Surgery. Turk J Anaesthesiol Reanim. 2022 Aug;50(4):261-266. doi: 10.5152/TJAR.2022.21209. PMID: 35979972; PMCID: PMC9524406.
[37] Rehman Shamsi MF, Siddiqui AS. Frequency Of Inappropriate Endotracheal Tube Cuff Pressure And Its Variability In Patients Undergoing Prolonged Surgery: A Prospective Observational Study. J Ayub Med Coll Abbottabad. 2023 Apr-Jun;35(2):301-306. doi: 10.55519/JAMC-02-11858. PMID: 37422826.
[38] Wang WZ, Zhou YY, Wang ZJ, Zhu ML, Yao XY, Yu JD, Lin YH, Yu FY, Wu CY, Zhang HH, Lou D, Hu YH. A mobile terminal application program was used for endotracheal tube cuff pressure measurement. J Clin Monit Comput. 2021 May;35(3):463-468. doi: 10.1007/s10877-020-00499-7. Epub 2020 Mar 18. PMID: 32189165; PMCID: PMC7224015.
[39] Braz JR, Navarro LH, Takata IH, Nascimento Júnior P. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J. 1999 Nov 4;117(6):243-7. doi: 10.1590/s1516-31801999000600004. PMID: 10625887.
[40] Nasrolahzadeh S, Nourian J, Khosravi A, Ghasempour S, Abbasi A, Ebrahimi H. Comparison of the effect of pressure control and volume control ventilation on endotracheal tube cuff pressure in patients undergoing general anesthesia and mechanical ventilation: a parallel randomized clinical trial. BMC Anesthesiol. 2023 Sep 5;23(1):300. doi: 10.1186/s12871-023-02263-1. PMID: 37670235; PMCID: PMC10478180.
[41] Seyed Siamdoust SA, Mohseni M, Memarian A. Endotracheal Tube Cuff Pressure Assessment: Education May Improve but not Guarantee the Safety of Palpation Technique. Anesth Pain Med. 2015 Jun 22;5(3):e16163. doi: 10.5812/aapm.5(3)2015.16163. PMID: 26161313; PMCID: PMC4493730.
[42] Hung WC, Ko JC, Weil AB, Weng HY. Evaluation of Endotracheal Tube Cuff Pressure and the Use of Three Cuff Inflation Syringe Devices in Dogs. Front Vet Sci. 2020 Feb 6;7:39. doi: 10.3389/fvets.2020.00039. PMID: 32118062; PMCID: PMC7015870.