Annals of Emergency Medicine
Volume 56, Issue 2 , Pages 89-93.e1, August 2010

Endotracheal Tube Intracuff Pressure During Helicopter Transport

Department of Anesthesia, University Hospital Basel, Basel, and the Swiss Air Rescue Organisation, Zurich, Switzerland

Received 8 June 2009; received in revised form 7 July 2009, 4 December 2009 and 1 January 2010; accepted 25 January 2010. published online 26 February 2010.

Study objective

We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H2O during aeromedical transport.

Methods

During a 12-month period, a helicopter-based rescue team prospectively recorded intracuff pressures of mechanically ventilated patients before takeoff and as soon as the maximum flight level was reached. With a commercially available pressure manometer, intracuff pressure was adjusted to ≤25 cm H2O before loading of the patient. The endpoint of our investigation was the increase of endotracheal tube cuff pressure during helicopter transport.

Results

Among 114 intubated patients, mean altitude increase was 2,260 feet (95% confidence interval [CI] 2,040 to 2,481 feet; median 2,085 feet; interquartile range [IQR] 1,477.5 to 2,900 feet). Mean flight time was 14.8 minutes (95% CI 13.1 to 16.4 minutes; median 13.5 minutes; IQR 10 to 16.1 minutes). Intracuff pressure increased from 28.7 cm H2O (95% CI 27.0 to 30.4 cm H2O [median 25 cm H2O; IQR 25 to 30 cm H2O]) to 62.6 cm H2O (95% CI 58.8 to 66.5 cm H2O; median 58; IQR 48 to 72 cm H2O). At cruising altitude, 98% of patients had intracuff pressures ≥30 cm H2O, 72% had intracuff pressures ≥50 cm H2O, and 20% even had intracuff pressures ≥80 cm H2O.

Conclusion

Endotracheal cuff pressure during transport frequently exceeded 30 cm H2O during aeromedical transport. Hospital and out-of-hospital practitioners should measure and adjust endotracheal cuff pressures before and during flight.

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 Supervising editor: Henry E. Wang, MD, MS

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funding was provided by the Department of Anesthesia, University Hospital Basel. The Swiss Air-Rescue Organisation helped collect the data.

 Author contributions: MB and MZ were responsible for conception of the study. MB and J-JE designed the study. MB was responsible for statistical analysis of the data. MB, MZ, and WU interpreted the data and drafted the article. MZ was responsible for statistical consulting. MZ and WU revised the article critically for important intellectual content. J-JE was responsible for selection of patients and critical revision of the article. WU had final approval of the article. WU takes responsibility for the paper as a whole.

 Reprints not available from the authors.

 Please see page 90 for the Editor's Capsule Summary of this article.

 Publication date: Available online February 25, 2010.

PII: S0196-0644(10)00098-3

doi:10.1016/j.annemergmed.2010.01.025

Annals of Emergency Medicine
Volume 56, Issue 2 , Pages 89-93.e1, August 2010

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