Authors: Gomes J et al.
Source: Cureus. 17(11): e96956. DOI: 10.7759/cureus.96956.
Summary:
This prospective clinical audit examined how often pediatric endotracheal tube cuff pressures fall outside the recommended safe range of 20–30 cmH₂O during general anesthesia. Over one month, 45 pediatric patients undergoing elective or urgent procedures were evaluated immediately after intubation and again at the end of surgery using an objective manometer.
After induction, only 37.8% of patients had cuff pressures within the acceptable range; nearly two-thirds had either underinflation or overinflation. Even after correction to 20–30 cmH₂O, pressures frequently drifted during the case, and by the end of surgery only 46.7% remained in range, while 51.1% fell below 20 cmH₂O and 2.2% exceeded 30 cmH₂O. Age showed a moderate positive correlation with final cuff pressure, suggesting older children tended to have higher pressures. Procedure duration and tube type had no meaningful impact.
Most procedures were ENT surgeries, where shared airways and surgical manipulation may contribute to pressure variability. The authors note that subjective estimation techniques (palpation, predetermined inflation volumes) are unreliable, and that despite strong evidence supporting cuff pressure monitoring, it remains inconsistently practiced.
The audit underscores the risk of both inadequate seal and excessive pressure, each with potential complications ranging from aspiration and inadequate ventilation to airway edema and mucosal injury. The findings reinforce that objective manometry should be routinely used not only after intubation but periodically throughout anesthesia to maintain safe cuff pressures.
What You Should Know:
• Most pediatric cuff pressures are incorrect when only subjective inflation methods are used.
• Even after correction, pressures often drift out of range during surgery.
• Older children tend to have higher end-of-case cuff pressures.
• Procedure duration and tube type do not appear to significantly influence pressure changes.
• Routine, repeated manometer-guided measurements could substantially reduce airway complications.
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