Best evidence statement (BESt) Tracheal cuff pressure management

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

An implementation strategy was not provided.

If cuff is over distended tracheal damage can occur and if cuff is underinflated inadequate ventilation can occur and/or aspiration.

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Search Strategy

• Databases: Medline, CINAHL, Google Scholar
• Search Terms: Cuff pressures, endotracheal tubes, tracheostomy tubes, minimal leak technique, minimal occlusive volume
• Limits, Filters, Search Dates: Neonatal, Pediatric; 2001-2009
• Date Search Done: April 2012-August 2012

Not stated

Table of Evidence Levels

†a = good quality study; b = lesser quality study

Not stated

Not stated

A formal cost analysis was not performed and published cost analyses were not reviewed.

This Best Evidence Statement has been reviewed against quality criteria by 2 independent reviewers from the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

Not applicable: The guideline was not adapted from another source.

Cincinnati Children's Hospital Medical Center

Not stated

Team Leader/Author: Jessica Sexton, BHS, RRT-NPS, Transitional Care Center & Neonatal Intensive Care Unit

Team Members/Co-Authors: Tonie Perez, BHS, RRT-NPS, Neonatal Intensive Care Unit; Amy Wolf, BS, RRT-NPS, Transport

Support/Consultant: Cyndi White, MSc, RRT-NPS, FAARC, Research Respiratory Therapist

Conflict of interest declaration forms are filed with the Cincinnati Children's Hospital Medical Center Evidence-based Decision Making (CCHMC EBDM) group. No financial or intellectual conflicts of interest were found.

This is the current release of the guideline.

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center Web site.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

The following are available:

• Judging the strength of a recommendation. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 May 7. 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.
• Grading a body of evidence to answer a clinical question. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 May 7. 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.
• Table of evidence levels. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2009 May 7. 1 p. Available from the Cincinnati Children's Hospital Medical Center Web site.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

In addition, suggested process or outcome measures are available in the original guideline document.

None available

This NGC summary was completed by ECRI Institute on May 23, 2013.

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

• Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
• Hyperlinks to the CCHMC website may be placed on the organization's website
• The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
• Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

Diseases and conditions requiring cuffed endotracheal tubes or cuffed tracheostomy tubes

To evaluate, in pediatric patients with cuffed endotracheal or tracheostomy tubes, if minimal leak technique (MLT)/minimal occlusive volume (MOV) technique compared to using a cuff manometer is a more effective way to measure cuff pressures

Neonatal and pediatric patients with a cuffed endotracheal tube or cuffed tracheostomy tube

Effectiveness of measuring cuff pressures

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the "Major Recommendations" field.

It is recommended that cuff pressure be measured in the neonatal and pediatric population.

Note 1: There are no studies that compare any one of these measurement approaches to another in neonates and pediatrics therefore one approach over another cannot be recommended. Research among the neonatal and pediatric populations would prove beneficial.

Note 2: At Cincinnati Children's Hospital Medical Center (CCHMC), current policy is to utilize minimal occlusive volume (MOV) and measure pressures with a cuff manometer, at least once per shift.

Definitions:

Table of Evidence Levels

†a = good quality study; b = lesser quality study

Table of Recommendation Strength

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

None provided