Cuff pressure monitoring by manual palpation in intubated patients: How accurate is it? A manikin simulation study

BackgroundEndotracheal intubation (ETI) for mechanical ventilation has a central role in the Intensive Care Unit (ICU). ETI is one of the main risk factors for the development of ventilator-associated pneumonia (VAP) as its presence reduces the natural defences of the upper airway and allows the micro-suction of secretions in the airways. In order to minimise such complications, it is fundamental to maintain a suitable pressure inside the tube cuff.Aim and scopeThe main objective of the present study is to evaluate the effectiveness and reliability of palpation method, performed with the operators fingers, for detecting the tube cuff pressure.ResultsThe study was performed using a manikin to test the pressure of the ETT cuff, on a sample constituted by nurses employed in three Italian ICU from two different Umbrian hospitals.From a total of 68 participants, detection by palpation method revealed to be not correct in 68% of cases; in particular, only 10% of respondents can correctly detect a pressure in the recommended range (20-30 cmH2O) using palpation.Moreover it was possible to highlight that the participation in emergency courses has a positive effect on the correct measurement of cuff pressure using the palpation method (V = 0.501).ConclusionsThe study, in agreement with the literature, confirms the thesis that the palpation method is inadequate to determine an estimate of the pressure existing inside the cuff.