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The College of Emergency Medicine and The Irish Association for Emergency Medicine Autumn meeting

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Roderick Little Prize Session

Wednesday 24 September, Burke Theatre


1M. Chopra, 1L. Jones, 1C. Boulanger, 2J. Benger, 2I. Higginson, 2D. Williamson, 2P. Younge, 1G. Lloyd. 1Royal Devon and Exeter Hospital, Exeter, UK, 2Other ED in the Southwest, UK

Introduction: Tracheal mucosal blood flow is impaired when tracheal cuff pressure is above 30 cm of water with the potential for tracheal mucosal necrosis. Previous studies have found excessive cuff pressures in simulated patients intubated by north American emergency physicians (Hoffman) as well as in patients intubated in the prehospital setting (Galinski) and emergency departments (ED) (Hoffman). We aimed to assess whether patients intubated in a UK prehospital setting or ED had excessive tracheal tube cuff pressures.

Methods: Prospective observational study in five ED in southwest England over a 2-month period. All patients older than 18 years and intubated either in the prehospital setting or within the ED were included. Clinicians independent to the patients’ care recorded the following data: age, sex, presenting complaint and indication for intubation, tube size and cuff pressure. Neither the paramedics nor the ED staff were aware of the purpose of the study. Cuff pressure measurements were recorded using a standardised cuff inflator pressure gauge (Portex; Smiths Medical). Excessive pressures were adjusted accordingly.

Results: 61 patients were recruited. The median and mean cuff pressure was 58 cm and 62 cm, respectively. 75% of patients had a cuff pressure greater than 30 cm of water. The median cuff pressures in those patients intubated by senior emergency physicians, junior emergency physicians and paramedics were 60, 43 and 80 cm, respectively.

Conclusion: We have demonstrated excessive tracheal cuff pressures in the majority of patients intubated both in the prehospital setting and ED. This is in keeping with existing evidence. We recommend early measurement and …

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