STUDY OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
STUDY OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.