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Excessive Endotracheal Tube Cuff Pressure in the Pediatric Emergency Room
Edward (Ted) Ferenczy, MD, Mike Stoner, MD, Sandra Spencer, MD, DJ Scherzer, MD, Samantha Gee, MD, and Joseph Tobias, MD, Nationwide Children's Hospital, Columbus OH

Abstract:
Objective:
Our primary outcome is to find the proportion of children exposed to excessive intracuff pressure after emergency intubation. How cuff pressure correlates with patient age, gender, weight, etc. were also analyzed individually as secondary outcomes. Methods: This is a single center observational cohort study. There was no change in clinical practice dictated for patients enrolled in this study. Any patient who arrived intubated with a cuffed ETT or who was intubated with a cuffed ETT was eligible for enrollment. Cuff pressure was measured directly with a hand held manometer. Additional data was collected for analysis of secondary outcomes. Results: At the time of writing, the cohort includes 86 patients. Age: 5 days to 20 years old. Weight: 2.6 to 102.3 kilograms � Gender: 49 boys and 37 girls � Average intracuff pressure: 36.8 cmH2O. Median intracuff pressure: 30 cmH2O Cuff pressure was elevated (?30 cmH2O) in 55% of patients enrolled (N = 47). Incidence of extremely high cuff pressure (?60 cmH2O) was 16% (N=14). Conclusions: More than half of pediatric patients emergently intubated were exposed to an intracuff pressure greater than the recommended upper limit of 29cmH2O. Excessive cuff pressure can cause ischemic injury to the tracheal mucosa. Further study is recommended to identify methods that limit cuff pressure after emergency intubation in children.Figures:

Objective:
The learner will be able to explain the importance of measuring and limiting the cuff pressure of endotracheal tubes in the pediatric patient.Objective Content:
At the end of discussing this poster with the lead presenter (or hearing a presentation) the learner will be able to 1. Give a brief history of tracheostomy and endotracheal intubation 2. Identify changes in technology that have allowed for use of cuffed endotracheal tubes in children, 3. Discuss changes in the classical dogma of pediatric airway anatomy due to modern imaging studies and 4. Discuss the importance of maintaining a safe intracuff pressure in intubated patients.


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