Endotracheal tube intracuff pressure during helicopter transport.

Abstract

We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H(2)O during aeromedical transport. 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 < or =25 cm H(2)O before loading of the patient. The endpoint of our investigation was the increase of endotracheal tube cuff pressure during helicopter transport. 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 H(2)O (95% CI 27.0 to 30.4 cm H(2)O [median 25 cm H(2)O; IQR 25 to 30 cm H(2)O]) to 62.6 cm H(2)O (95% CI 58.8 to 66.5 cm H(2)O; median 58; IQR 48 to 72 cm H(2)O). At cruising altitude, 98% of patients had intracuff pressures > or =30 cm H(2)O, 72% had intracuff pressures > or =50 cm H(2)O, and 20% even had intracuff pressures > or =80 cm H(2)O. Endotracheal cuff pressure during transport frequently exceeded 30 cm H(2)O during aeromedical transport. Hospital and out-of-hospital practitioners should measure and adjust endotracheal cuff pressures before and during flight.