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The Pressure Is On: Endotracheal Tube Cuff Pressure in the Pediatric Trauma Bay
Nicole P. Reavis, BSN, RN, RNC-NIC, Tammy Rush, MSN, RN, C-NPT, EMT, Rosland M. Baskerville, RRT, C-NPT, John K. Petty, MD, FACS. Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.

Background: A pediatric trauma patient sustained a tracheal injury related to sustained high endotracheal tube cuff pressure (ETCP). This prompted a review of our procedure for evaluating ETCP. Opportunity for improvement: We identified an opportunity to check ETCP earlier in the trauma resuscitation, during the trauma bay phase of care.

Methods: We initiated a process for measuring and recording ETCP in the trauma bay for all children who arrive intubated or become intubated in the trauma bay.

Old Practice: ETCP was not evaluated or tracked in the trauma bay. Previously, initial evaluation of cuff pressure occurred in the Pediatric Intensive Care Unit.

New Practice: ETCP was measured and documented by the Respiratory Therapist in the "Airway" assessment of the primary survey. All cuff pressures found greater than 30cm H2O were immediately decreased to within an acceptable range.

Results: Respiratory care supervisor provided education to each Respiratory Therapist responding to pediatric trauma activations.

Conclusions: 100% compliance with evaluation and documentation of initial cuff pressure after educational initiative. Chart review revealed that most initial cuff pressures were above recommended parameters.

Future Steps: Extending education on checking ETCP to pre hospital providers and referral facilities may further improve outcomes. Assessment for the uncommon iatrogenic tracheal injury from elevated ETCP is ongoing.


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