33. In the later years, however, they can administer anesthesia either independently or under remote supervision. supported this recommendation [18]. The high incidence of postextubation airway complaints in this study is most likely a site-specific problem but one that other resource-limited settings might identify with. The datasets analyzed during the current study are available from the corresponding author on reasonable request. The study was approved by Makerere University College of Health Sciences, School of Medicine Research Ethics Committee (SOMREC), The Secretariat Makerere University College of Health Sciences, Clinical Research Building, Research Co-ordination Office, P.O. 101, no. Also, at the end of the pressure measurement in both groups, the manometer was detached, breathing circuit was attached to the ETT, and ventilation was started. The cookie is used to store and identify a users' unique session ID for the purpose of managing user session on the website. J. R. Bouvier, Measuring tracheal tube cuff pressurestool and technique, Heart and Lung, vol. Fred Bulamba, Andrew Kintu, Arthur Kwizera, and Arthur Kwizera were responsible for concept and design, interpretation of the data, and drafting of the manuscript. Volume + 2.7, r2 = 0.39. The total number of patients who experienced at least one postextubation airway symptom was 113, accounting for 63.5% of all patients. This is a standard practice at these hospitals. Intensive Care Med. A syringe is inserted into the valve and depressed until a suitable intracuff pressure is reached. Every patient was wheeled into the operating theater and transferred to the operating table. statement and The author(s) declare that they have no competing interests. 6, pp. Measured cuff pressures averaged 35.3(21.6)cmH2O; only 27% of the patients had measured pressures within the recommended range of 2030 cmH2O. Article Note correct technique: While securing the ET tube with one hand, inflate the cuff with 5-10 cc's of air. mental status changes, such as confusion . Kim and coworkers, who evaluated this method in the emergency department, found an even higher percentage of cuff pressures in the normal range (2232cmH2O) in their study. 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. If pressure remains > 30 cm H2O, Evaluate . However, these are prohibitively expensive to acquire and maintain in many operating theaters, and as such, many anesthesia providers resort to subjective methods like pilot balloon palpation (PBP) which is ineffective [1, 2, 1620]. However, this could be a site-specific outcome. ETT cuff pressure estimation by the PBP and LOR methods. 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. Note: prolonged over-inflation of the cuff can cause pressure necrosis of the tracheal mucosa. At the study hospital, there are more females undergoing elective surgery under general anesthesia compared with males. Error in Inhaled Nitric Oxide Setup Results in No Delivery of iNO. AW contributed to protocol development, patient recruitment, and manuscript preparation. Decrease the cuff pressure to 30 cm H2O by withdrawing a small amount of air from the balloon with a 10 mL syringe. 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. When this point was reached, the 10ml syringe was then detached from the pilot balloon, and a cuff manometer (VBM, Medicintechnik Germany. Fifty percent of the values exceeded 30 cmH2O, and 27% of the measured pressures exceeded 40 cmH2O. 3, p. 172, 2011. Summary Aeromedical transport of mechanically ventilated critically ill patients is now a frequent occurrence. Used to track the information of the embedded YouTube videos on a website. This is used to present users with ads that are relevant to them according to the user profile. It is however difficult to extrapolate these results to the human population since the risk of aspiration of gastric contents is zero while working with models when compared with patients. C) Pressure gauge attached to pilot balloon of normal cuff reading 30 mmHg with cuff inflated. V. Foroughi and R. Sripada, Sensitivity of tactile examination of endotracheal tube intra-cuff pressure, Anesthesiology, vol. The Human Studies Committee did not require consent from participating anesthesia providers. A. Secrest, B. R. Norwood, and R. Zachary, A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement, American Journal of Nurse Anesthestists, vol. This point was observed by the research assistant and witnessed by the anesthesia care provider. Find out how to properly inflate an endotracheal tube cuff and troubleshoot common errors. 30. When considering this primary outcome, the LOR syringe method had a significantly higher proportion compared to the PBP method. C. K. Cho, H. U. Kwon, M. J. Lee, S. S. Park, and W. J. Jeong, Application of perifix(R) LOR (loss of resistance) syringe for obtaining adequate intracuff pressures of endotracheal tubes, Journal of Korean Society of Emergency Medicine, vol. In the control ETT, the cuff was inflated to 20 mm Hg to 22 mm Hg and not manipulated. Patients with emergency intubations, difficult intubations, or intubation performed by non-anesthesiology staff; pregnant women; patients with higher risk for aspiration (e.g., full stomach, history of reflux, etc. In case of a very low pressure reading (below 20cmH, https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. 32. R. Fernandez, L. Blanch, J. Mancebo, N. Bonsoms, and A. Artigas, Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement, Critical Care Medicine, vol. Air leaks are a common yet critical problem that require quick diagnosis. We evaluated three different types of anesthesia provider in three different practice settings. 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). Taking another approach to the same question, we also determined compliance of the cuff-trachea system in vivo by plotting measured cuff pressure against cuff volume. Precaution was taken to avoid premature detachment of the loss of resistance syringe in this study. Accuracy 2cmH. Continuous data are presented as the mean with standard deviation and were compared between the groups using the t-test to detect any significant statistical differences. LOR group (experimental): in this group, the research assistant attached a 7ml plastic, luer slip loss of resistance syringe (BD Epilor, USA) containing air onto the pilot balloon. 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. In contrast, newer ultra-thin cuff membranes made from polyurethane effectively prevent liquid flow around cuffs inflated only to 15 cm H2O [2]. 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. - 20-25mmHg equates to between 24 and 30cmH2O. Up to ten pilots at a time sit in the . The overall trend suggests an increase in the incidence of postextubation airway complaints in patients whose cuff pressures were corrected to 3140cmH2O compared with those corrected to 2030cmH2O. 6, pp. Statement on the Standard Practice for Infection Prevention and Control Instruments for Tracheal Intubation. 2, pp. High-volume low-pressure cuffed endotracheal tubes (ETT) are the standard of airway protection. A wide-bore intravenous cannula (16- or 18-G) was placed for administration of drugs and fluids. Anaesthesist. 208211, 1990. 1977, 21: 81-94. Compliance of the cuff system was evaluated by linear regression of measured cuff pressure vs. measured cuff volume. The manual method used a pressure manometer to adjust pressure at cruising altitude and after landing. Google Scholar. This single-blinded, parallel-group, randomized control study was performed at Mulago National Referral Hospital, Uganda. BMC Anesthesiology Lien TC, Wang JH: [Incidence of pulmonary aspiration with different kinds of artificial airways]. The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. Morphometric and demographic characteristics of the patients were similar at each participating hospital (Table 1). Aire cuffs are "mid-range" high volume, low pressure cuffs. The hospital has a bed capacity of 1500 inpatient beds, 16 operating rooms, and a mean daily output of 90 surgical operations. E. Resnikoff and A. J. Katz, A modified epidural syringe as an endotracheal tube cuff pressure-controlling device, Anaesthesia and Analgesia, vol. Upon inflation, folds form along the cuff surface, and colonized oropharyngeal secretions may leak through these folds. We use this to improve our products, services and user experience. Nor did measured cuff pressure differ as a function of endotracheal tube size. The distribution of cuff pressures (unadjusted) achieved by the different care providers is shown in Figure 2. Below are the links to the authors original submitted files for images. After cuff inflation, a persistent significant air leak was noted (> 1 L/min in volume controlled ventilation modality). BMC Anesthesiol 4, 8 (2004). Cuff pressure is essential in endotracheal tube management. Methods With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. demonstrate the presence of legionellae in aerosol droplets associated with suspected bacterial reservoirs. 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. Laura F. Cavallone, MD, Associate Professor, Department of Anesthesiology, Washington University in St. Louis, MO. Google Scholar. Part 1: anaesthesia, British Journal of Anaesthesia, vol. Tracheal Tube Cuff. Thus, appropriate inflation of endotracheal tube cuff is obviously important. We appreciate the assistance of Diane Delong, R.N., B.S.N., Ozan Aka, M.D., and Rainer Lenhardt, M.D., (University of Louisville). . Cuff Pressure Measurement Check the cuff pressure after re-inflating the cuff and if there are any concerns for a leak. All these symptoms were of a new onset following extubation. Inflate the cuff with 5-10 mL of air. This method provides a viable option to cuff inflation. These data suggest that tube size is not an important determinant of appropriate cuff inflation volume. Cuff pressures less than 20 cmH2O 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. Anasthesiol Intensivmed Notfallmed Schmerzther. Anesthetists were blinded to study purpose. However, increased awareness of over-inflation risks may have improved recent clinical practice. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The tube is kept in place by a small cuff of air that inflates around the tube after it is inserted. There is consensus that keeping ETT cuff pressures low decreases the incidence of postextubation airway complaints [11]. M. H. Bennett, P. R. Isert, and R. G. Cumming, Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuffa randomized controlled trial, Anesthesia and Analgesia, vol. 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. To achieve the optimal ETT cuff pressure of 2030cmH2O [3, 8, 1214], ETT cuffs should be inflated with a cuff manometer [15, 16]. But opting out of some of these cookies may have an effect on your browsing experience. 720725, 1985. Currently, in critical care settings, patients are intubated with ETT comprising high-volume low-pressure cuffs. Endotracheal Tube Cuff Inflation The Gurney Room 964 subscribers Subscribe 7.2K views 2 years ago Learn how to inflate an endotracheal tube cuff the right way, including a trick to do it. This point was observed by the research assistant and witnessed by the anesthesia care provider. 965968, 1984. One study, for instance, found that cuff pressure exceeded 40 cm H2O in 40-to-90% of tested patients [22]. 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. 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. Abstract: An endotracheal tube includes a main tubular portion including a distal end and a proximal end opposite the distal end, the main tubular portion including a central lumen at least in part defined by a wall of the main tubular portion; a . Evrard C, Pelouze GA, Quesnel J: [Iatrogenic tracheal and left bronchial stenoses. In general, the cuff inflates properly for adults, but physicians often over-inflate the cuff during . This has been shown to cause severe tracheal lesions and morbidity [7, 8]. This cookie is used by the WPForms WordPress plugin. Hahnel J, Treiber H, Konrad F, Eifert B, Hahn R, Maier B, Georgieff M: [A comparison of different endotracheal tubes. The cookie is set by Google Analytics and is deleted when the user closes the browser. Anesthesia was maintained with a volatile aesthetic in a combination of air and oxygen; nitrous oxide was not used during the study period. Neither patient morphometrics, institution, experience of anesthesia provider, nor tube size influenced measured cuff pressure (35.3 21.6 cmH2O). Compared with the cuff manometer, it would be cheaper to acquire and maintain a loss of resistance syringe especially in low-resource settings. 1993, 42: 232-237. Seegobin and Hasselt reached similar conclusions in an in vitro study and recommended cuff inflation pressure not exceed 30 cm H2O [20]. . This however was not statistically significant ( value 0.052). The patients were followed up and interviewed only once at 24 hours after intubation for presence of cough, sore throat, dysphagia, and/or dysphonia. The relationship between measured cuff pressure and volume of air in the cuff. 12, pp. Previous studies suggest that this approach is unreliable [21, 22]. Google Scholar. 1981, 10: 686-690. Perioperative Handoffs: Achieving Consensus on How to Get it Right, APSF Website Offers Online Educational DVDs, APSF Announces the Procedure for Submitting Grant Applications, Request for Applications (RFA) for the Safety Scientist Career Development Award (SSCDA), http://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/statement-on-standard-practice-for-infection-prevention-for-tracheal-intubation.pdf. Crit Care Med. Box 7072, Kampala, Uganda (Email: rresearch9@gmail.com; research@chs.mak.ac.ug). ); and patients with known anatomical laryngeo-tracheal abnormalities were excluded from this study. A newer method, the passive release technique, although with limitations, has been shown to estimate cuff pressures better [2124]. We recorded endotracheal tube size and morphometric characteristics including age, sex, height, and weight. The entire process required about a minute. Figure 2. Measured cuff volume averaged 4.4 1.8 ml. Sengupta, P., Sessler, D.I., Maglinger, P. et al. 3, pp. However, they have potential complications [13]. 686690, 1981. 21, no. It has been demonstrated that, beyond 50cmH2O, there is total obstruction to blood flow to the tracheal tissues. CRNAs (n = 72), anesthesia residents (n = 15), and anesthesia faculty (n = 6) performed the intubations. In an experimental study, Fernandez et al. Lomholt N: A device for measuring the lateral wall cuff pressure of endotracheal tubes. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Alternative, cheaper methods like the minimum leak test that require no special equipment have produced inconsistent results. A) Normal endotracheal tube with 10 ml of air instilled into cuff. Informed consent was sought from all participants. 2, pp. Cuff pressure reading of the VBM manometer was recorded by the research assistant. We included ASA class I to III adult patients scheduled to receive general anesthesia with endotracheal intubation for elective surgical operation. Support breathing in certain illnesses, such . It should however be noted that some of these studies have been carried out in different environments (emergency rooms) and on different kinds of patients (emergency patients) by providers of varying experience [2]. 1992, 49: 348-353. The loss of resistance syringe was then detached, the VBM manometer was attached, and the pressure reading was recorded. Conventional high-volume, low-pressure cuffs may not prevent micro-aspiration even at cuff pressures up to 60 cm H2O [2], although some studies suggest that only 25 cm H2O is sufficient [3]. 14231426, 1990. Part of The poster can be accessed by following the link: https://pdfs.semanticscholar.org/c12e/50b557dd519bbf80bd9fc60fb9fa2474ce27.pdf. However, complications have been associated with insufficient cuff inflation. If the silicone cuff is overinflated air will diffuse out. LOR group (experimental): in this group, the research assistant attached a 7ml plastic, luer slip loss of resistance syringe (BD Epilor, USA) containing air onto the pilot balloon. At the hypobaric chamber at the RAAF base in Edinburgh several hundred air force pilots each year get to check out their reactions to depressurization and the effects of hypoxia. The cookie is created when the JavaScript library executes and there are no existing __utma cookies. . With the patients head in a neutral position, the anesthesia care provider inflated the ETT cuff with air using a 10ml syringe (BD Discardit II). Anesthesia services are provided by different levels of providers including physician anesthetists (anesthesiologists), residents, and nonphysician anesthetists (anesthetic officers and anesthetic officer students). Retrieved from. 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]. 513518, 2009. How do you measure cuff pressure? Acta Anaesthesiol Scand. This cookie is set by Google analytics and is used to store the traffic source or campaign through which the visitor reached your site. Advertisement cookies help us provide our visitors with relevant ads and marketing campaigns. We similarly found that the volume of air required to inflate the cuffs to 20 cmH2O did not differ significantly as a function of endotracheal tube size. Related cuff physical characteristics, Chest, vol. An initial intracuff pressure of 30 cmH2O decreased to 20 cmH2O at 7 to 9 hours after inflation. distance from the tip of the tube to the end of the cuff, which varies with tube size. This however was not statistically significant ( value 0.053) (Table 3). 6, pp. S1S71, 1977. chest pain or heart failure. 48, no. Listen for the presence of an air leak around the cuff during a positive pressure breath. Sanada Y, Kojima Y, Fonkalsrud EW: Injury of cilia induced by tracheal tube cuffs. 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. Chest. U. Nordin, The trachea and cuff-induced tracheal injury: an experimental study on causative factors and prevention, Acta Oto-Laryngologica, vol. Heart Lung. The study groups were similar in relation to sex, age, and ETT size (Table 1). Categorical data are presented in tabular, graphical, and text forms and categorized into PBP and LOR groups. Smooth Murphy Eye. Acta Anaesthesiol Scand. Article (Supplementary Materials). Advance the endotracheal tube through the vocal cords and into the trachea within 15 seconds. 1mmHg equals how much cmH2O? The cuff was then progressively inflated by injecting air in 0.5-ml increments until a cuff pressure of 20 cmH2O was achieved. Bivona "Aire-cuff" Tracheostomy Tubes - Blue pilot balloon) Portex manufacturer, Bivona design This is the routine practice in all three hospitals. The compliance of the tube was determined from the measured cuff pressure (cmH2O) and the volume of air (ml) retrieved at complete deflation of the cuff; this showed a linear pressure-volume relationship: Pressure= 7.5. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. Tobin MJ, Grenvik A: Nosocomial lung infection and its diagnosis. S. W. Wangaka, Estimation of endotracheal tube cuff pressures at Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya, 2006. Analytics cookies help us understand how our visitors interact with the website. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. 175183, 2010. Measured cuff inflation pressures were virtually identical at the three study sites: one academic center and two private hospitals. None of these was met at interim analysis. Secondly, this method is still provider-dependent as they decide when plunger drawback has ceased. Outcomes Research Institute, University of Louisville, 501 E. Broadway, Suite 210, Louisville, KY, 40202, USA, Papiya Sengupta,Daniel I Sessler&Anupama Wadhwa, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 530 S. Jackson St. University Hospital, Louisville, KY, 40202, USA, Daniel I Sessler,Paul Maglinger,Jaleel Durrani&Anupama Wadhwa, School of Medicine, University of Louisville School of Medicine, Louisville, KY, 40292, USA, You can also search for this author in The Khine formula method and the Duracher approach were not statistically different. This was a randomized clinical trial. The integrity of the entire breathing circuit and correct positioning of the ETT between the vocal cords with direct laryngoscopy were confirmed. In case of a very low pressure reading (below 20cmH2O), the ETT cuff pressure would be adjusted to 24cmH2O using the manometer. 9, no. 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. 775778, 1992. 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). Consequences of micro-aspiration of oropharyngeal secretions include nosocomial pulmonary infections [1]. Endotracheal intubation is a medical procedure in which a tube is placed into the windpipe (trachea) through the mouth or nose. Clear tubing. Pressure was recorded at end-expiration after ensuring that the patient was paralyzed. We did not collect data on the readjustment by the providers after intubation during this hour. Inflate the cuff of the endotracheal tube with sufficient air to seal the area between the trachea and the tube. Students were under the supervision of a senior anesthetic officer or an anesthesiologist. The anesthesia providers were either physician anesthetists (anesthesiologists or residents) or nonphysicians (anesthetic officer or anesthetic officer student). 2, p. 5, 2003. 10, no. American Society of Anesthesiology, Committee of Origin: Committee on Quality Management and Departmental Administration (QMDA). PubMed 36, no. We also appreciate the statistical analysis by Gilbert Haugh, M.S., and the editorial assistance of Nancy Alsip, Ph.D., (University of Louisville). Does that cuff on the trach tube get inflated with air or water? A critical function of the endotracheal tube cuff is to seal the airway, thus preventing aspiration of pharyngeal contents into the trachea and to ensure that there are no leaks past the cuff during positive pressure ventilation. The individual anesthesia care providers participated more than once during the study period of seven months. 2017;44 Anaesthesist. Routine checks of the ETT integrity and functionality before insertion used to be the standard of care, but the practice is becoming less common, although it is still recommended in current ASA guidelines.1. Endotracheal tube system and method . Bunegin L, Albin MS, Smith RB: Canine tracheal blood flow after endotracheal tube cuff inflation during normotension and hypotension. ETT cuff pressures would be measured with a cuff manometer following estimation by either the PBP method or the LOR method. These included an intravenous induction agent, an opioid, and a muscle relaxant. These cookies do not store any personal information. The patient was the only person blinded to the intervention group. Intubation was atraumatic and the cuff was inflated with 10 ml of air. Correspondence to Anesth Analg. However, the performance of the air filled tracheal tube cuff at altitude has not been studied in vivo. 443447, 2003. Cuff pressure should be measured with a manometer and, if necessary, corrected. Privacy With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals. What are the . Curiel Garcia JA, Guerrero-Romero F, Rodriguez-Moran M: [Cuff pressure in endotracheal intubation: should it be routinely measured?]. Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. "Aire" indicates cuff to be filled with air. SP oversaw day-to-day study mechanics, collected data on many of the patients, and wrote an initial draft of manuscript. Product Benefits. Acta Otorhinolaryngol Belg. studied the relationship between cuff pressure and capillary perfusion of the rabbit tracheal mucosa and recommended that cuff pressure be kept below 27 cm H2O (20 mmHg) [19]. 2023 BioMed Central Ltd unless otherwise stated. The authors wish to thank Ms. Martha Nakiranda, Bachelors of Arts in Education, Makerere University, Uganda, for her assistance in editing this manuscript. - 10 mL syringe. The cookies collect this data and are reported anonymously. J. Liu, X. Zhang, W. Gong et al., Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study, Anesthesia and Analgesia, vol. We offer in-person, hands-on training at our Asheville, N.C., Spay/Neuter Training Cent Show more. . allows one to provide positive pressure ventilation. Striebel HW, Pinkwart LU, Karavias T: [Tracheal rupture caused by overinflation of endotracheal tube cuff]. In the absence of clear guidelines, many clinicians consider 20 cm H2O a reasonable lower limit for cuff pressure in adults. We recommend that ET cuff pressure be set and monitored with a manometer. In addition, acquired laryngeal stenosis may be caused by mechanical abrasion or pressure necrosis of the laryngeal mucosa secondary to high cuff pressure [13, 14]. 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. With approval of the University of Louisville Human Studies Committee and informed consent, we recruited 93 patients (42 men and 51 women) undergoing elective surgery with general endotracheal anesthesia from three hospitals in Louisville, Kentucky: 41 patients from University Hospital (an academic centre), 32 from Jewish Hospital (a private hospital), and 20 from Norton Hospital (also a private hospital). 1985, 87: 720-725. 111115, 1996. Our results are consistent in that measured cuff pressure exceeded 30 cmH2O in 50% of patients and were less than 20 cmH2O in 23% of patients. Findings from this study were in agreement, with 25.3% of cuff pressures in the optimal range after estimation by the PBP method. 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).