The investigation of initial endotracheal tube cuff pressures in the operating room: a multi-center cross-sectional study in China

Abstract

Abstract Cuffed endotracheal tubes (ETTs) are widely used in general anesthesia, with recommended cuff pressure (CP) between 20 and 30 cmH 2 O in adults. This multi-center study investigated actual CP management practices across 19 Grade A tertiary hospitals in China, involving 2058 anesthetized patients. The median initial CP measured within 30 min post-intubation was 48 cmH 2 O (IQR 32–70), with only 19% within the recommended range (75.4% > 30 cmH 2 O; 5.6% < 20 cmH 2 O). All institutions demonstrated similarly suboptimal CP management. Four distinct methods were used for cuff pressure estimation: pilot balloon palpation (96.2%), fixed-volume inflation (2.8%), minimal occlusive volume technique (0.7%), and direct manometry (0.2%). Among them, only direct manometry demonstrated reliable accuracy in achieving appropriate pressures. The remaining three methods showed no clear superiority over one another in terms of pressure assessment accuracy. In orotracheally intubated patients with palpation-estimated CP, independent risk factors for elevated pressure (> 30 cmH 2 O) included: age < 60 years, pressure-controlled ventilation, absence of PEEP, ETT internal diameter < 7.0 mm, aminosteroid neuromuscular blocker use, and trainee-performed inflation. These findings highlight widespread challenges in optimal CP management across Chinese tertiary care centers.