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Prospective observational measurement of tracheal tube cuff pressures in the emergency department
  1. Michelle Chopra1,
  2. Lewis Jones1,
  3. Carole Boulanger1,
  4. Jonathan Benger2,
  5. Ian Higginson3,
  6. Dominic Williamson4,
  7. Paul Younge5,
  8. Gavin Lloyd1
  1. 1Emergency Department, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2Emergency Department, University Hospital, Bristol, Bristol, UK
  3. 3Emergency Department, Derriford Hospital, Plymouth, UK
  4. 4Emergency Department, Royal United Hospital, Bath, UK
  5. 5Emergency Department, Frenchay Hospital, North Bristol, UK
  1. Correspondence to Dr Lloyd Gavin, Emergency Department, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK; gavin.lloyd{at}


Background Tracheal mucosal blood flow is impaired when tracheal tube 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 as well as patients intubated in the prehospital setting and emergency department (ED). This study assessed whether patients intubated in a UK prehospital setting or ED had excessive cuff pressures.

Method Prospective observational study in five ED in southwest England over a 2-month period. All patients over 18 years and intubated in the prehospital setting or in the ED were included. Clinical staff independent of the patients' care recorded the following: age, sex, presenting complaint and indication for intubation, tube size and cuff pressure. Neither the paramedics nor the participating ED staff were aware of the study purpose. Cuff pressure measurements were recorded using a standardised cuff inflator pressure gauge.

Result 61 patients were recruited. The median and mean cuff pressures were 58 and 62 cm of water, 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 70, 46 and 79 cm of water, respectively.

Conclusion Excessive tracheal tube cuff pressures were demonstrated in the majority of patients intubated both in the prehospital setting and ED. This is in keeping with existing evidence. Early measurement and adjustment of cuff pressures is recommended for those patients who require ongoing care.

  • Airway
  • critical care transport
  • emergency care systems
  • emergency departments
  • prehospital care

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  • Funding Funding for the study was provided by the College of Emergency Medicine, Churchill House, 35 Red Lion Square, London WC1R 4SG, UK.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.