ABSTRACT
Background : Inappropriated intracuff pressure (underpressure of overpressure) is the main cause of respiratory complications in intubated patients with mechanical ventilation such as aspiration, tidal volume leakage, tracheal ischemia, necrosis and stenosis etc. Subjective assessment by doctors or nurses that has very low reliability is the cause of inappropriated intracuff pressure Objective : to assess the efficiency of high volume, low pressure end tracheal tube cuff ressure measurement by subjective assessment.Design : A descriptive study.Setting : At Srinagarind hospital, faculty of Medicine, Khon Kaen university.Subjects : The study was completely done in 105 cases (54 male and 51 female patients) of intubated patients with mechanical ventilation at different wards (Surgery, medicine, ICU and Emergency)Measurements : Intracuff pressure was measured with fluid-filled quartz transducer (HP 1290 C) and Hewlett Packard Monitor (78354 C, Made in USA.) and then recorded in mmHgResults : It was found that intracuff pressure was appropriated in only 13.33% (normal range 20-25 mmHg) in all wards (Surgery 6.67%, Medicine 17.86%, ICU 13.64% and Emergency 11.11%) The rate of inappropriated intracuff pressure was 86.66% (underpressure 44.76% and overpressure 41.90%). There was no statistical significance in intracuff pressure assessment among patients from different wards.Conclusion : Endotracheal tube cuff inflation by subjective assessment was not accurate and unreliable. The use of objective systems for intracuff pressure measurement is useful, highly accurate and more reliable and should be routinely implemented. It can prevent or reduce respiratory complications if use as a routine practive and follow up every 1-2 hours in all intubatd patients.Key words : High volume, low pressure endotracheal tube cuff, intracuff pressure
ABSTRACT
Background : Inaccurate intracuff pressure of endotracheal tube (with measurements being too high or too low) is the main cause of respiratory complications in intubated patients, such as aspiration, tidal volume leakage, tracheal is chemia, necrosis or stenosis. Subjective assessments by physicians or nurses have very low reliability and are inaccurate. Objective measurements are more reliable, can reduce respiratory complication and should be the standard method used.Objective : To increase awareness among nureses of the complications of inaccurate intracuff pressure assessments; to encourage the use by nurese of a simple apparatus that provides more accrate measurements ; and to encourage the use of this method as a standard procedure for intubated patient.Design : Descriptive study..Setting : Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Subjects : 157 of 289 nurese (54.3%) who cared for intubated patients between 1 September 1997 and 30 April 1998.Meawurements: Date were collected by questionnaires before and after group meetings in which intracuff pressure measurements using a simple apparatus were demonstrated. The data were presented as percentages and means.Results : 84.1% of nurses accepted and agreed to use a new method. 93.6% of them accepted the method for routine nursing care.Conclusions : A large mafority of nurses accepted the objective measurements instead of their previous subjective assessments and thought that they should be the standard method for routine nursing care. The objective method can prevent or reduce respiratory complications in intubated patients.Key words : High volume low pressure endotracheal tube cuff, Intracuff pressure, Measurement, Apparatus.
ABSTRACT
Introduction: Doing research about routine patient care, so-called Routine to Research or R2R, can increase both the quantity of articles and quality of care. Objective: To determine the number of R2R-related articles by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, and their utilization.Study Design: descriptive studyMethods: Questionnaires to the corresponding authors of papers published between 2002 and 2005. We excluded case reports from the study and focused on basic data of researchers, number of articles that received funding, the number of R2R-related articles and their utilization. The data were analyzed and presented using descriptive statistics.Results: All 40 questionnaires were returned, representing 22 anesthesiologists’ articles (55%) and 18 nurse anesthetists’ articles (45%). Eighteen articles (45%) received funding. Thirty-six articles (90%) were classified as R2R-related articles: 12% have already been applied to routine patient care; 6 had potential for application provided they received suitable encouragement; 10% had less potential for application; and, 8% were non-applicable because of an unavailability of medications or equipment.Conclusion: Based on articles published by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, between 2002 and 2005, R2R-related articles comprised 90%, but only one-third have been applied to routine patient care while another 16.7% (or 15% of all articles) have potential for applications were they to receive suitable encouragement.