79th PostGraduate Assembly in Anesthesiology 2025

Detection and Prevention of Overinflation of the Tracheal Tube Cuff During Surgery at a Tertiary Care Hospital

Madeleine Ausburn, BSA1; Alex Iancau, BS1; Anna Hong, BS1; Girish P. Joshi, MBBS, MD, FFARCSI2; Eric B. Rosero, MD, MSc2

Department of Anesthesiology, UT Southwestern Medical Center

Background:

•Excessive inflation of tracheal cuff (pressure >30 cm H₂O) during intubation can lead to many complications, such as:

•Sore throat, +/- blood-streaked expectoration

•Obstruction of tracheal mucosa microvasculature of the tracheal mucosa à tracheal ischemia and ulceration.1

•Tracheal stenosis and/or rupture2

•Clinical studies indicate that tracheal cuff pressures are frequently higher than the recommended range.3

•Current practitioner adherence to recommended monitoring practices, such as using a manometer to ensure proper inflation, is inconsistent and influenced by factors such as limited access to supplies, time constraints, and gaps in provider education.4,5

Aim Statement:

Reduce tracheal cuff overinflation from a measured rate of 90% to 45% or below after educational intervention.

Methods:

•Study population: adult patients undergoing general anesthesia with tracheal intubation at Parkland Hospital

•Phase 1: Baseline tracheal cuff pressure data (n=100)

•Phase 2: Educational sessions given to anesthesia providers at Parkland that presented our baseline pressure readings and then demonstrated optimal cuff pressure measurement techniques (manometers).

•Phase 3: Re-evaluation of tracheal cuff pressures (n=63)

Results:

•Overall rate of over-inflation decreased by approximately 50%, from 90% pre-intervention to 44% post-intervention (P<0.0001).

oPost-intervention, cuff overinflation was lower in the first 8 weeks (23.5%) but increased to 52% during weeks 9-16.

•Mean cuff pressure decreased from 76.8 Cm H2O to 37.6 Cm H2O (p<.0001).

•A manometer was used in 59% of the cases after the intervention, compared to 1% of the cases before the presentation.

oWhen a manometer was employed, the rate of appropriate cuff inflation reached 70%, compared to only 19% when a manometer was not used.

Discussion:

•Significant reduction in tracheal cuff pressures following the intervention

•A targeted training initiative and accessible monitoring devices was effective in decreasing tracheal cuff overinflation, potentially enhancing safety in patients undergoing general anesthesia.

•Limitations: single-institution design (limited generalizability), and the relatively small sample size

•A notable concern is that the initial success observed immediately after the intervention waned over time.

•For sustained improvements, ongoing monitoring paired with regular educational refreshers could be beneficial to maintain these enhanced practices

79th PostGraduate Assembly in Anesthesiology 2025

Detection and Prevention of Overinflation of the Tracheal Tube Cuff During Surgery at a Tertiary Care Hospital

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