Symptoms of a severe air embolism might include: difficulty breathing or respiratory failure. Currently, in critical care settings, patients are intubated with ETT comprising high-volume low-pressure cuffs. All tubes had high-volume, low-pressure cuffs. This was a randomized clinical trial. 307311, 1995. 12, pp. The patient was the only person blinded to the intervention group. 1: anesthesia resident; 2: anesthesia officer; 3: anesthesia officer student; 4: anesthesiologist. . 1, p. 8, 2004. If an air leak is present, add just enough air to seal the airway and measure cuff pressure again. How to insert an endotracheal tube (intubation) for doctors and medical students, Video on how to insert an endotracheal tube, AnaestheticsIntensive CareOxygenShortness of breath. Manage cookies/Do not sell my data we use in the preference centre. We therefore also evaluated cuff pressure during anesthesia provided by certified registered nurse anesthetists (CRNAs), anesthesia residents, and anesthesia faculty. ); and patients with known anatomical laryngeo-tracheal abnormalities were excluded from this study. Young, and K. K. Duk, Usefulness of new technique using a disposable syringe for endotracheal tube cuff inflation, Korean Journal of Anesthesiology, vol. The Data Safety Management Board (DSMB) comprised an anesthesiologist, a statistician, and a member of the SOMREC IRB who would be informed of any adverse event. The Human Studies Committee did not require consent from participating anesthesia providers. . 1992, 74: 897-900. This cookies is installed by Google Universal Analytics to throttle the request rate to limit the colllection of data on high traffic sites. The size of ETT (POLYMED Medicure, India) was selected by the anesthesia care provider. The allocation sequence was generated by an Internet-based application with the following input: nine sets of unsorted sequences, each containing twenty unique allocation numbers (120). 1, pp. Chest. J. R. Bouvier, Measuring tracheal tube cuff pressurestool and technique, Heart and Lung, vol. However, no data were recorded that would link the study results to specific providers. Although the ETT pilot balloon was noted to be appropriately tense to the touch, a small amount of air was added to the cuff. All patients provided informed, written consent before the start of surgery. 1984, 12: 191-199. Tracheal Tube Cuff. 36, no. Fernandez R, Blanch L, Mancebo J, Bonsoms N, Artigas A: Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement. The end of the cuff must not impinge the opening of the Murphy eye; it must not herniate over the tube tip under normal conditions; and the cuff must inflate symmetrically around the ETT.1 All cuffs are part of a cuff system consisting of the cuff itself plus . Numbers 110 were labeled LOR, and numbers 1120 were labeled PBP. Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques. . There is a relatively small risk of getting ETT cuff pressures less than 30cmH2O with the use of the LOR syringe method [23, 24], 12.4% from the current study. To obtain an adequate seal, it is recommended to inflate the cuff initially to a no-audible leak point at applied airway pressures of 20 cm H 2 O. M. L. Sole, X. Su, S. Talbert et al., Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range, American Journal of Critical Care, vol. Morphometric and demographic characteristics of the patients were similar at each participating hospital (Table 1). 2001, 55: 273-278. Supported by NIH Grant GM 61655 (Bethesda, MD), the Gheens Foundation (Louisville, KY), the Joseph Drown Foundation (Los Angeles, CA), and the Commonwealth of Kentucky Research Challenge Trust Fund (Louisville, KY). https://doi.org/10.1186/1471-2253-4-8, DOI: https://doi.org/10.1186/1471-2253-4-8. Background Cuff pressure in endotracheal (ET) tubes should be in the range of 20-30 cm H2O. Measured cuff volume averaged 4.4 1.8 ml. On the other hand, overinflation may cause catastrophic complications. Air Leak in a Pediatric CaseDont Forget to Check the Mask! This is the routine practice in all three hospitals. An intention-to-treat analysis method was used, and the main outcome of interest was the proportion of cuff pressures in the range 2030cmH2O in each group. Compliance of the cuff system was evaluated by linear regression of measured cuff pressure vs. measured cuff volume. Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 21.6 cmH2O). Generally, the proportion of ETT cuffs inflated to the recommended pressure was less in the PBP group at 22.5% (20/89) compared with the LOR group at 66.3% (59/89) with a statistically significant positive mean difference of 0.47 with value<0.01 (0.3430.602). Also to note, most cuffs in the PBP group were inflated to a pressure that exceeded the recommended range in the PBP group, and 51% of the cuff pressures attained had to be adjusted compared with only 12% in the LOR group (Table 2). In the later years, however, they can administer anesthesia either independently or under remote supervision. We measured the tracheal cuff pressures at ground level and at 3000 ft, in 10 intubated patients. Cuff pressure reading of the VBM manometer was recorded by the research assistant. "Aire" indicates cuff to be filled with air. Seegobin RD, van Hasselt GL: Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. 23, no. Christina M. Brown, MD, Resident, Department of Anesthesiology, Washington University in St. Louis, MO. It is used to either assist with breathing during surgery or support breathing in people with lung disease, heart failure, chest trauma, or an airway obstruction. muscle or joint pains. Below are the links to the authors original submitted files for images. An anesthesia provider inserted the endotracheal tubes, and the intubator or the circulating registered nurse inflated the cuff. A pressure manometer is a hand hand held device used to measure tracheostomy tube cuff pressures. The authors wish to thank Ms. Martha Nakiranda, Bachelors of Arts in Education, Makerere University, Uganda, for her assistance in editing this manuscript. Because cuff inflation practices are likely to differ among clinical environments, we evaluated cuff pressure in three different practice settings: an academic university hospital and two private hospitals. 2003, 38: 59-61. This study was not powered to evaluate associated factors, but there are suggestions that the levels of anesthesia providers with varying skill set and technique at direct laryngoscopy may be associated with a high incidence of complications. 71, no. 6, pp. K. C. Park, Y. D. Sohn, and H. C. Ahn, Effectiveness, preference and ease of passive release techniques using a syringe for endotracheal tube cuff inflation, Journal of the Korean Society of Emergency Medicine, vol. Ann Chir. U. Nordin, The trachea and cuff-induced tracheal injury: an experimental study on causative factors and prevention, Acta Oto-Laryngologica, vol. But opting out of some of these cookies may have an effect on your browsing experience. R. D. Seegobin and G. L. van Hasselt, Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs, British Medical Journal, vol. (States: would deflate the cuff, pull tube back slightly -1 cm, re-inflate the cuff, and auscultate for bilateral air entry). Inflate the cuff with 5-10 mL of air. Over-inflation of an endotracheal tube (ETT) cuff may lead to tracheal mucosal irritation, tracheal wall ischemia or necrosis, whereas under-inflation increases the risk of pulmonary aspiration as well as leaking anesthetic gas and polluting the environment. Tube positioning within patient can be verified. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. This cookie is set by Google Analytics and is used to distinguish users and sessions. This is used to present users with ads that are relevant to them according to the user profile. Lien TC, Wang JH: [Incidence of pulmonary aspiration with different kinds of artificial airways]. However, increased awareness of over-inflation risks may have improved recent clinical practice. Dullenkopf A, Gerber A, Weiss M: Fluid leakage past tracheal tube cuffs: evaluation of the new Microcuff endotracheal tube. How to insert an endotracheal tube (ETT) Equipment required for ET tube insertion Laryngoscope (check size - the blade should reach between the lips and larynx - size 3 for most patients), turn on light Cuffed endotracheal tube Syringe for cuff inflation Monitoring: end-tidal CO2 monitor, pulse oximeter, cardiac monitor, blood pressure Tape Suction We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. In the early years of training, all trainees provide anesthesia under direct supervision. B) Defective cuff with 10 ml air instilled into cuff. Anasthesiol Intensivmed Notfallmed Schmerzther. The cookie is used to identify individual clients behind a shared IP address and apply security settings on a per-client basis. 1992, 36: 775-778. Precaution was taken to avoid premature detachment of the loss of resistance syringe in this study. Box 7072, Kampala, Uganda (Email: rresearch9@gmail.com; research@chs.mak.ac.ug). 7, no. Anesthetic officers provide over 80% of anesthetics in Uganda. Nor did measured cuff pressure differ as a function of endotracheal tube size. Figure 2. However, the performance of the air filled tracheal tube cuff at altitude has not been studied in vivo. Apropos of a case surgically treated in a single stage]. We use this to improve our products, services and user experience. Google Scholar. 87, no. 1995, 15: 655-677. 106, no. A newer method, the passive release technique, although with limitations, has been shown to estimate cuff pressures better [2124]. Up to ten pilots at a time sit in the . C) Pressure gauge attached to pilot balloon of normal cuff reading 30 mmHg with cuff inflated. Our secondary objective was to determine the incidence of postextubation airway complaints in patients who had cuff pressures adjusted to 2030cmH2O range or 3140cmH2O range. [21] found that the volume of air required to inflate the endotracheal tube cuff varies as a function of tube size and type. Anesth Analg. Guidelines recommend a cuff pressure of 20 to 30 cm H2O. BMC Anesthesiology In the control ETT, the cuff was inflated to 20 mm Hg to 22 mm Hg and not manipulated. The cookie is updated every time data is sent to Google Analytics. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. 2023 BioMed Central Ltd unless otherwise stated. Patients who were intubated with sizes other than these were excluded from the study. In case of a very low pressure reading (below 20cmH, https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. 6, pp. J. Rello, R. Soora, P. Jubert, A. Artigas, M. Ru, and J. Valls, Pneumonia in intubated patients: role of respiratory airway care, American Journal of Respiratory and Critical Care Medicine, vol. Sanada Y, Kojima Y, Fonkalsrud EW: Injury of cilia induced by tracheal tube cuffs. 21, no. Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, http://www.biomedcentral.com/1471-2253/4/8/prepub. Article N. Suzuki, K. Kooguchi, T. Mizobe, M. Hirose, Y. Takano, and Y. Tanaka, Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator, Masui, vol. chest pain or heart failure. leaking cuff: continuous air insufflation through the inflation tubing has been describe to maintain an adequate pressure in the perforated cuff; . The air leak resolved with the new ETT in place and the cuff inflated. The rate of optimum endotracheal tube cuff pressure was 90.5% in the group guided by manometer and 31.8% in the conventional procedure group (p < 0.001 . February 2017 1mmHg equals how much cmH2O? Consecutive available patients were enrolled until we had recruited at least 10 patients for each endotracheal tube size at each participating hospital. Uncommon complication of Carlens tube. Cuff pressures were thus less likely to be within the recommended range (2030 cmH2O) than outside the range. 617631, 2011. SuperWes explains how to know the difference.Thx to Caleb@BDM Films for the FX Alternatively, cheaper, reproducible methods, like the minimum leak test that limit overly high cuff pressures should be sought and evaluated. The regression equation indicated that injected volumes between 2 and 4 ml usually produce cuff pressures between 20 and 30 cmH2O independent of tube size for the same type of tube. Product Benefits. In our case, had the endotracheal tube been checked prior to the start of the case, the defect could have been easily identified which would have obviated the need for tube exchange. Measured cuff pressures averaged 35.3(21.6)cmH2O; only 27% of the patients had measured pressures within the recommended range of 2030 cmH2O. Male patients were intubated with an 8 or 8.5 mm internal diameter endotracheal tube, and female patients were intubated with a 7 or 7.5 mm internal diameter endotracheal tube. Previous studies have shown that the incidence of postextubation airway symptoms varies from 15% to 94% in various study populations [7, 9, 11, 27] and could be affected by the method of interview employed, such as the one used in our study (yes/no questions). 1993, 76: 1083-1090. Decrease the cuff pressure to 30 cm H2O by withdrawing a small amount of air from the balloon with a 10 mL syringe. CAS E. Resnikoff and A. J. Katz, A modified epidural syringe as an endotracheal tube cuff pressure-controlling device, Anaesthesia and Analgesia, vol. 2003, 29: 1849-1853. 2003, 13: 271-289. While it is likely that these results are fairly representative, it is obvious that results would not be identical elsewhere because of regional practice differences. 2016 National Geriatric Surgical Initiatives, 2017 EC Pierce Lecture: Safety Beyond Our Borders, The Anesthesia Professionals Role in Patient Safety During TAVR (Transcatheter Aortic Valve Replacement). Charles Kojjo, Agnes Wabule, and Nodreen Ayupo were responsible for patient recruitment and data collection and analysis. The cuff was considered empty when no more air could be removed on aspiration with a syringe. Although it varied considerably, the amount of air required to achieve a cuff pressure of 20 cmH2O was similar with each tube size. Cuff pressures less than 20cmH2O have been shown to predispose to aspiration which is still a major cause of morbidity, mortality, length of stay, and cost of hospital care as revealed by the NAP4 UK study. Volume + 2.7, r2 = 0.39. Inflation of the cuff of . [22] observed cuff pressure exceeding 40 cm H2O in 91% of PACU patients after anesthesia with nitrous oxide, 55% of ICU patients, and 45% of PACU patients after anesthesia without nitrous oxide. [21] observed that when the cuff was inflated randomly to 10, 20, or 30 cmH2O, participating physicians and ICU nurses were able to identify the group in 69% of the high-pressure cases, 58% of the normal pressure cases, and 73% of the low pressure cases. B) Dye instilled into the defective endotracheal tube stops at the entrance of the pilot balloon tubing into the main tubing (arrow in Figure 2A and 2B). Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J: Sore throat after endotracheal intubation. 1). Cuff pressure in tube sizes 7.0 to 8.5 mm was evaluated 60 min after induction of general anesthesia using a manometer connected to the cuff pilot balloon. Curiel Garcia JA, Guerrero-Romero F, Rodriguez-Moran M: [Cuff pressure in endotracheal intubation: should it be routinely measured?]. The loss of resistance syringe was then detached, the VBM manometer was attached, and the pressure reading was recorded. This adds to the growing evidence to support the use of the LOR syringe for ETT cuff pressure estimation. PubMedGoogle Scholar. Although this was a single-blinded, single-centre study, results suggest that the LOR syringe method was superior to PBP at administering pressures in the optimal range. 1993, 104: 639-640. Issue PDF, We are writing to call attention to the often under-appreciated importance of checking the endotracheal tube (ETT) prior to the start of the procedure. 10, pp. However, a major air leak persisted. There was no correlation between the measured cuff pressure and the age, sex, height, or weight of the patients. We also appreciate the statistical analysis by Gilbert Haugh, M.S., and the editorial assistance of Nancy Alsip, Ph.D., (University of Louisville). It is also likely that cuff inflation practices differ among providers. An endotracheal tube : provides a passage for gases to flow between a patients lungs and an anaesthesia breathing system . Anaesthesist. 10.1055/s-2003-36557. Cite this article. As newer manufacturing techniques have decreased the occurrence of ETT defects, routine assessments of the ETT cuff integrity prior to use have become increasingly less common among providers. 31. 1981, 10: 686-690. stroke. Summary Aeromedical transport of mechanically ventilated critically ill patients is now a frequent occurrence. 6, pp. One such approach entails beginning at the patient and following the circuit to the machine. This method has been achieved with a modified epidural pulsator syringe [13, 18], a 20ml disposable syringe, and more recently, a loss of resistance (LOR) syringe [21, 23, 24]. Bivona "Aire-cuff" Tracheostomy Tubes - Blue pilot balloon) Portex manufacturer, Bivona design All data were double entered into EpiData version 3.1 software (The EpiData Association, Odense, Denmark), with range, consistency, and validation checks embedded to aid data cleaning. Related cuff physical characteristics, Chest, vol. Even with a 'good' cuff seal, there is still a risk of micro-aspiration (Hamilton & Grap, 2012), especially with long-term ventilation in the . H. M. Kim, J. K. No, Y. S. Cho, and H. J. Kim, Application of a loss of resistance syringe for obtaining the adequate cuff pressures of endotracheal intubated patients in an emergency department, Journal of the Korean Society of Emergency Medicine, vol. 775778, 1992. General anesthesia was induced by intravenous bolus of induction agents, and paralysis was achieved with succinylcholine or a non-depolarizing muscle relaxant. 408413, 2000. CRNAs (n = 72), anesthesia residents (n = 15), and anesthesia faculty (n = 6) performed the intubations. The study was approved by the School of Medicine Research and Ethics Committee, Makerere University, and registered with http://www.clinicaltrials.gov (NCT02294422). Secures tube using commercially approved tube holder. The allocation sequence was concealed from the investigator by inserting it into opaque envelopes (according to the clocks) until the time of the intervention. 30. Only 27% of pressures were within 2030 cmH2O; 27% exceeded 40 cmH2O. Chest. These data suggest that management of cuff pressure was similar in these two disparate settings. Blue radio-opaque line. Measured cuff inflation pressures were virtually identical at the three study sites: one academic center and two private hospitals. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. In low- and middle-income countries, the cost of acquiring ($ 250300) and maintaining a cuff manometer is still prohibitive. C. Stein, G. Berkowitz, and E. Kramer, Assessment of safe endotracheal tube cuff pressures in emergency care - time for change? South African Medical Journal, vol. 1984, 24: 907-909. With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. L. Gilliland, H. Perrie, and J. Scribante, Endotracheal tube cuff pressures in adult patients undergoing general anaesthesia in two Johannesburg Academic Hospitals, Southern African Journal of Anaesthesia and Analgesia, vol. However, a full hour was plenty of time for the provider to have checked and adjusted cuff pressure to a suitable level. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. Cuff pressure in . 3 11331137, 2010. El-Orbany M, Salem MR. Endotracheal tube cuff leaks: causes, consequences, and management. After deflating the cuff, we reinflated it in 0.5-ml increments until pressure was 20 cmH2O. The loss of resistance syringe was then detached, the VBM manometer was attached, and the pressure reading was recorded. However, less serious complications like dysphagia, hoarseness, and sore throat are more prevalent [911]. PBP group (active comparator): in this group, the anesthesia care provider was asked to reduce or increase the pressure in the ETT cuff by inflating with air or deflating the pilot balloon using a 10ml syringe (BD Discardit II) while simultaneously palpating the pilot balloon until a point he or she felt was appropriate for the patient. The pressure reading of the VBM was recorded by the research assistant. To detect a 15% difference between PBP and LOR groups, it was calculated that at least 172 patients would be required to be 80% certain that the limits of a 95%, two-sided interval included the difference. Pediatr Pathol Lab Med. 21, no. The study would be discontinued if 5% of study subjects in one study group experienced an adverse event associated with the study interventions as determined by the DSMB, or if a value of <0.001 was obtained on an interim analysis performed halfway through patient accrual. Cuff pressure can be easily measured with a small aneroid manometer [23], but this device is not widely available in the United States. This cookie is installed by Google Analytics. volume4, Articlenumber:8 (2004) 345, pp. The Khine formula method and the Duracher approach were not statistically different. 1985, 87: 720-725. Braz JR, Navarro LH, Takata IH, Nascimento Junior P: Endotracheal tube cuff pressure: need for precise measurement. statement and Endotracheal intubation is done to: Keep the airway open in order to give oxygen, medicine, or anesthesia. Endotracheal tube cuff pressure: a randomized control study comparing loss of resistance syringe to pilot balloon palpation. 2006;24(2):139143. Students were under the supervision of a senior anesthetic officer or an anesthesiologist. The data collected including the number visitors, the source where they have come from, and the pages visited in an anonymous form. CONSORT 2010 checklist. Heart Lung. The authors declare that they have no conflicts of interest. We recognize that people other than the anesthesia provider who actually conducted the case often inflated the cuffs. 10, no. P. Sengupta, D. I. Sessler, P. Maglinger et al., Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure, BMC Anesthesiology, vol. The manual method used a pressure manometer to adjust pressure at cruising altitude and after landing. These data suggest that tube size is not an important determinant of appropriate cuff inflation volume. They were only informed about the second purpose of the study: determining the relationship between cuff volume and pressure. The cookies store information anonymously and assign a randomly generated number to identify unique visitors. Hahnel J, Treiber H, Konrad F, Eifert B, Hahn R, Maier B, Georgieff M: [A comparison of different endotracheal tubes. Measure 5 to 10 mL of air into syringe to inflate cuff. Upon closer inspection of the ETT that had been removed from the airway, there appeared to be a defect in which the air injected into the pilot balloon did not reach the cuff (see Figures 1 and 2). 24, no. The relationship between measured cuff pressure and volume of air in the cuff. This study set out to determine the efficacy of the loss of resistance syringe method at estimating endotracheal cuff pressures. By clicking Accept, you consent to the use of all cookies. Anesthesia services are provided by different levels of providers including physician anesthetists (anesthesiologists), residents, and nonphysician anesthetists (anesthetic officers and anesthetic officer students). Fernandez et al. The cuff was then briefly overinflated through the pilot balloon, and the loss of resistance syringe plunger was allowed to passively draw back until it ceased. Intensive Care Med. After induction of anesthesia, a 71-year-old female patient undergoing a parotidectomy was nasally intubated with a TaperGuard 6.5 Nasal RAE tube using a C-MAC KARL STORZ GmbH & Co. KG Mittelstrae 8, 78532 Tuttlingen, Germany, video-laryngoscope. COPD, head injury, ARDS), Rapid sequence induction (RSI) intubation, Procedural variation using rapid anaesthetisation with cricoid pressure to prevent aspiration while airway is quickly secured, Used for patients at risk of aspiration e.g. On the other hand, high cuff pressures beyond 50cmH2O were reduced to 40cmH2O. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat]. Another study, using nonhuman tracheal models and a wider range (1530cmH2O) as the optimal, had all cuff pressures within the optimal range [21]. Perhaps the LOR syringe method needs to be evaluated against the no air leak on auscultation method. One study, for instance, found that cuff pressure exceeded 40 cm H2O in 40-to-90% of tested patients [22]. This cookie is set by Youtube and registers a unique ID for tracking users based on their geographical location. Dont Forget the Routine Endotracheal Tube Cuff Check! The cookie is created when the JavaScript library executes and there are no existing __utma cookies. Pelc P, Prigogine T, Bisschop P, Jortay A: Tracheoesophageal fistula: case report and review of literature. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. 513518, 2009. mental status changes, such as confusion . 1999, 117: 243-247. Pressure was recorded at end-expiration after ensuring that the patient was paralyzed. The cookie is used to store and identify a users' unique session ID for the purpose of managing user session on the website. However, the presence of contradictory findings (tense cuff bulb, holding appropriate inflating pressure in the presence of a major air leak) confounded the diagnostic process, while a preoperative check of the ETT would have unequivocally detected the defect in the cuff tube. At the study hospital, there are more females undergoing elective surgery under general anesthesia compared with males. Notes tube markers at front teeth, secures tube, and places oral airway. The datasets analyzed during the current study are available from the corresponding author on reasonable request. We appreciate the assistance of Diane Delong, R.N., B.S.N., Ozan Aka, M.D., and Rainer Lenhardt, M.D., (University of Louisville). Standard cuff pressure is 25mmH20 measured with a manometer. Laura F. Cavallone, MD, Associate Professor, Department of Anesthesiology, Washington University in St. Louis, MO. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2253/4/8/prepub. 70, no. A caveat, though, is that tube sizes were chosen by clinicians in our study and presumably matched patient size; results may well have differed if tube size had been randomly assigned. R. J. Hoffman, V. Parwani, and I. H. Hahn, Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques, American Journal of Emergency Medicine, vol. Low pressure high volume cuff. All authors read and approved the final manuscript. Anaesthesist. Intubation was atraumatic and the cuff was inflated with 10 ml of air. When this point was reached, the 10ml syringe was then detached from the pilot balloon, and a cuff manometer (VBM, Medicintechnik Germany. A syringe attached to the third limb of the stopcock was then used to completely deflate the cuff, and the volume of air removed was recorded. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Our primary outcomes were 1) measured endotracheal tube cuff pressures as a function of tube size, provider, and hospital; and 2) the volume of air required to produce a cuff pressure of 20 cmH2O as a function of tube size. Data are presented as means (SD) or medians [interquartile ranges] unless otherwise noted; P < 0.05 was considered statistically significant. The individual anesthesia care providers participated more than once during the study period of seven months.