Using Manometers in Operating Rooms for Endotracheal Tube Cuff Pressure Measurements

Abstract

Problem & Purpose: Postoperative sore throat represents a common adverse event following general endotracheal anesthesia. Anesthesia providers play an integral role in preventing postoperative sore throat by minimizing airway trauma, selecting appropriate size blades and endotracheal tubes, and maintaining optimal intracuff pressures at 20-30 cm H2O using manometers. Cuff over-inflation leads to tracheal mucosa damage, while cuff under-inflation leads to micro-aspiration and tube migration. At a small Maryland community hospital, the incidence of postoperative sore throat was 38%. This quality improvement project aimed to implement the use of manometers in operating rooms for intraoperative endotracheal tube cuff pressure monitoring. Methods: The practice change involved anesthesia providers measuring and documenting endotracheal tube cuff pressures with manometers after intubation. Eligible patients included adults scheduled for elective surgery. Electronic chart audits were completed to track provider compliance and cuff pressures. Post-anesthesia care unit nurses monitored postoperative sore throat occurrence. Data collection was performed weekly and analyzed using descriptive statistics and run charts. Results: The sample included a total of 146 patients. Following implementation of manometers into operating rooms, median anesthesia provider compliance to endotracheal tube cuff pressure monitoring and optimal cuff pressures improved from 0% to 26% and 0% to 69% respectively. The average percentage of patients who denied POST symptoms in the recovery unit was 83%. Conclusions: Manometer utilization in operating rooms at this organization was feasible. Findings suggest that routine intraoperative measurements and maintenance of cuff pressures between 20-30 cm H2O reduces postoperative sore throat occurrence in adults.