Intraoperative Cuff Pressure Monitoring of Airway Devices: An Evidence-Based Educational Intervention

Background and Review of Literature: Subjective methods for assessing airway device cuff pressures (CP) remain in use to determine correct inflation, despite evidence indicating inadequate sensitivity for identifying under and overinflation. Inadequate CP can cause tissue ischemia, mucosal ulcers, stenosis, and aspiration. Recommendations for endotracheal tubes (ETT) CP are 20 to 30 cm H2O and ≤ 60 cmH2O for supraglottic airway (SGA) devices. Currently, there are no guidelines for intraoperative monitoring of airway devices. Manometers are the most accurate and accepted method for assessing CP; however, they are underutilized intraoperatively. Purpose: The project goal was to promote CP assessment intraoperatively with manometry and create a practice guideline for measuring and monitoring CP. Methods: A literature review was performed to evaluate recent evidence on CP assessment for airway devices to develop practice guidelines for intraoperative monitoring of CP. A group of 23 licensed anesthesia providers participated in the project. Pre-and post-surveys were utilized. Evaluation of current knowledge, methodology, rating of importance, and willingness to adopt manometry for CP intraoperative monitoring was obtained. Education on CP monitoring was discussed with participants, followed by post-survey. Pre-survey was used to evaluate participants’ current methods for ETT and SGA CP assessment. During routine intubation, participants were asked to inflate an airway device using their preferred technique to determine adequate CP. Readings for CP were measured using a manometer device approved by the Food and Drug Administration (FDA). Data for their corresponding CP reading was shared with participants, and educational information reflecting current evidence for CP monitoring. Post-survey was then performed to evaluate the participants’ willingness to adapt CP assessment with manometry into their practice. Conclusion: Intraoperative CP was predominantly performed with subjective techniques. Anesthesia providers expressed a willingness to assess CP with manometry, posing education as a possible foundational step for future implemention of CP monitoring in the operating room (OR). Lack of guidelines for CP monitoring intraoperatively and variability in monitoring CP due to subjective assessment methods emphasized the need for standardization and the increased availability of manometry devices for intraoperative use