Nurses’ Knowledge and Management of Endotracheal/Tracheostomy Tube Cuff Pressure in Intensive Care Units During COVID-19 Pandemic

Year 2025, Volume: 14 Issue: 3, 1186 - 1194, 25.09.2025

Nurdan Yalçın Atar , Eda Aydın Birkanım , Semra Açıksöz

https://doi.org/10.37989/gumussagbil.1611444

Abstract

This cross-sectional study aimed to evaluate the knowledge and practices of nurses working in intensive care units (ICUs) regarding endotracheal/tracheostomy tube cuff pressure during the COVID-19 pandemic. A total of 90 nurses from ICUs where these procedures were performed participated in the study. Data were collected using a Participant Information Form and the Endotracheal/Tracheostomy Tube Cuff Pressure Knowledge and Practice Form. Nurses identified the primary function of the cuff as tube fixation (88.90%), the main complication as lung aspiration (73.30%), and the safe cuff pressure range as 20–30 cmH2O (56.70%). Most nurses inflated the cuff with 5–10 ml of air (57.80%) and measured the pressure at least twice daily (58.90%), using palpation method (78.90%). Nurses had theoretical knowledge regarding cuff function, complications, pressure amount, and measurement frequency; however, they need training about the practical aspects of cuff pressure management, such as the air volume injected into the cuff, measurement position, and technique.

Keywords

COVID-19 , Cuff Pressure , Endotracheal Tube , Intensive Care , Tracheostomy Tube.

Ethical Statement

The institutional permission and Ethics Committee approval were obtained from the institution where the study was conducted (Date:10.01.2020, No: 2138). The informed consent obtained from the individuals participating in the study in line with the Declaration of Helsinki.

Yoğun Bakım Ünitelerinde Çalışan Hemşirelerin COVID-19 Pandemisi Sırasında Endotrakeal/Trakeostomi Tüp Kaf Basıncı Bilgi ve Uygulamaları

Abstract

Bu kesitsel çalışma, COVID-19 pandemisi sırasında yoğun bakım ünitelerinde (YBÜ) çalışan hemşirelerin endotrakeal/traheostomi tüpü kaf basıncı bilgi ve uygulamalarını değerlendirmeyi amaçlamıştır. Çalışmaya, bu işlemlerin yapıldığı YBÜ'lerde görevli 90 hemşire katılmıştır. Veriler, Katılımcı Bilgi Formu ve Endotrakeal/Trakeostomi Tüpü Kaf Basıncı Bilgi ve Uygulama Formu kullanılarak toplanmıştır. Hemşireler kafın birincil işlevini tüp sabitleme (%88,90), en önemli komplikasyonunu akciğer aspirasyonu (%73,30) ve güvenli kaf basıncı aralığını 20-30 cmH2O (%56,70) olarak belirtmiştir. Çoğu hemşire, kafı 5-10 ml hava ile şişirmiş (%57,80) ve basıncı günde en az iki kez ölçmüştür (%58,90), ölçüm için palpasyon yöntemini kullanmıştır (%78,90). Hemşirelerin kaf fonksiyonu, komplikasyonlar, basınç miktarı, ölçüm sıklığı gibi teorik bilgilerinin olduğu, ancak kaf içine verilen hava miktarı, ölçüm pozisyonu ve yöntemi gibi kaf basıncı yönetimine yönelik uygulamalar açısından uygulamalı eğitim gereksinimleri olduğu saptanmıştır.

Keywords

COVID-19 , Endotrakeal Tüp , Kaf Basıncı , Trakeostomi Tüpü , Yoğun Bakım

References

• 1. Baran İ, Altinsoy S, Yamankılıç ÖM, Dönmez A. High intraoperative cuff pressure incidence due to endotracheal cuff inflation methods and its clinical effects. Journal of Anesthesiology and Reanimation Specialists’ Society. 2019;27(3):217-223. https://doi.org/10.5222/jarss.2019.41636
• 2. Jordan PJ, Van Rooyen DV, Venter D. Endotracheal tube cuff pressure management in adult critical care units. Southern African Journal of Critical Care. 2012;28(1):13-16. https://doi.org/10.7196/sajcc.129
• 3. Soyer Ö, Giersbergen MYV. The Effect of Endotracheal Tube Cuff Pressure Control on the Development of Microaspiration and Ventilator-Associated Pneumonia: Systematic Review. Turkish Journal of Intensive Care.2020;18(3):129-138. https://doi.org/10.4274/tybd.galenos.2019.25582
• 4. Taslimi L, Khaleghdoost TM, Ghanbari AK, Kazemnezhad EL. Endotracheal tube cuff pressure continuous monitoring in intensive care units’ patients. Journal of Nursing and Midwifery Sciences.2018;5(2):63-67. https://doi.org/10.4103/JNMS.JNMS_18_18
• 5. Maddumage M, Gunasekara A, Priyankara WD. Endotracheal tube cuff pressure management in adult critical care units in the National Hospital of Sri Lanka; A baseline audit. Sri Lankan Journal of Anaesthesiology. 2017;25(1):31-34. https://doi.org/10.4038/slja.v25i1.8199
• 6. Nseir S, Brisson H, Marquette CH, et al. Variations in endotracheal cuff pressure in intubated critically ill patients: Prevalence and risk factors. European Journal of Anaesthesiology.2009;26(3):229-234. https://doi.org/10.1097/EJA.0b013e3283222b6e
• 7. Turner MA, Feeney M, Deeds LJL. Improving endotracheal cuff inflation pressures: An evidence-based project in a military medical center. Journal of the American Association of Nurse Anesthesiology. 2020;88(3):203-208.
• 8. Murugiah UR, Ramoo V, Jamaluddin MFH, et al. Knowledge acquisition and retention among nurses after an educational intervention on endotracheal cuff pressure. Nursing in Critical Care . 2021;26(5):363-371. https://doi.org/10.1111/nicc.12600
• 9. Özbayır T, Taşdemir N, Van Giersbergen MY, Çankaya G, Dinçaslan G. Endotracheal cuff pressure monitoring: Clinical pilot study. Journal of Ege University Nursing Faculty. 2018;34(2):44-54.
• 10. Rose L, Redl L. Survey of cuff management practices in intensive care units in Australia and New Zealand. American Journal of Critical Care. 2008;17(5):428-435. https://doi.org/10.4037/ajcc2008.17.5.428
• 11. Sole ML, Su X, Talbert S, et al. Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range. American Journal of Critical Care. 2011;20(2):109-118. https://doi.org/10.4037/ajcc2011661
• 12. Hedberg P, Eklund C, Högqvist S. Identification of a very high cuff pressure by manual palpation of the external cuff balloon on an endotracheal tube. Journal of the American Association of Nurse Anesthesiology. 2015;83(3):179-182.
• 13. Akhtar MI. Awareness regarding application of endotracheal tube (ETT) cuff pressure measuring gauge in anesthesia practice; a critical step to avoid postintubation tracheal stenosis in critically ill patients on prolonged mechanical ventilator. Journal of the College of Physicians and Surgeons Pakistan. 2016;26(7):635.
• 14. Tekin YE, İyigün E. Investigation of the nurses' tracheostomy/endotracheal tube cuff pressure practices in intensive care units. Turkiye Klinikleri Journal of Nursing Sciences. 2016;8(1):26-33.
• 15. Labeau SO, Bleiman M, Rello J, Vandijck DM, Claes B, Blot SI. Knowledge and management of endotracheal tube cuffs. International Journal of Nursing Studies. 2015;52(1):498-499. https://doi.org/10.1016/j.ijnurstu.2014.09.010
• 16. Mol DA, De Villiers GT, Claassen AJ, Joubert G. Use and care of an endotracheal/tracheostomy tube cuff—Are intensive care unit staff adequately informed? South African Journal of Surgery. 2004;42(1):14-16.
• 17. Nwosu ADG, Ossai EN, Onyekwulu FA, et al. Knowledge and practice of tracheal tube cuff pressure monitoring: a multicenter survey of anaesthesia and critical care providers in a developing country. Patient Safety in Surgery. 2022;16(4):1-8.
• 18. Orandi A, Mireskandari SM, Samadi S, Eftekhar N, Mohammadi M, Aminizadeh M. Evaluation of endotracheal tube cuff pressure in intubated patients in emergency department, operating rooms, and ICUs of Imam Khomeini Hospital Complex in 2018; A cross-sectional study. Archives of Anesthesia and Critical Care. 2021;7(2):69-74. https://doi.org/10.18502/aacc.v7i2.6299
• 19. Whitmore KA, Townsend SC, Laupland KB. Management of tracheostomies in the intensive care unit: A scoping review. BMJ Open Respiratory Research. 2020;7(1):1-9.
• 20. Ghanbari A, Sharif-Nia H, Mousazadeh N, Nazari R. Development and Validation of a Scale for Assessing Factors Influencing Nurses' Intention to Use a Manometer for Endotracheal Tube Cuff Pressure Monitoring. Journal of Critical Care Nursing. 2024;17(1):65-75.
• 21. Valentim M, Barbosa J, Almeida M, Alves S, Salgado H. Optimizing Patient Safety: Unveiling the Significance of Cuff Pressure in Anaesthesia. Trends in Anaesthesia and Critical Care. 2024;58:1-5.
• 22. Mohamed MM, Ali ZH, Hassan SN. The Relationship Between Endotracheal Tube Different Cuff Pressure Measurements and The Incidence of Ventilator-Associated Pneumonia. International Journal of Chemical and Biochemical Sciences. 2024;24(8):83-92.
• 23. Mpasa F, van Rooyen DRM, Venter D, Jordan P, Ten Ham-Baloyi W. Improving nurses' knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study. Health SA Gesondheid.2020;25:1479.
• https://doi.org/10.4102/hsag.v25i0.1479 24. Soyer Ö, Özyürek P, Giersbergen MYV. The effect of endotracheal tube cuff pressure control training on nurses' knowledge level. Turkish Journal of Intensive Care. 2020;18(3):146-154. https://doi.org/10.4274/tybd.galenos.49389
• 25. Sultan P, Carvalho BÇ, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: A review of the evidence. Journal Of Perioperative Practice. 2011;21(11):379-386. https://doi.org/10.1177/175045891102101103
• 26. Zidan D, Oweida EMAA, Zaitoun TM, Mohammed EHH. Monitoring of endotracheal tube cuff pressure in occurrence of ventilator associated pneumonia in neuro-critically ill patients. The Egyptian Journal of Bronchology. 2025;19(1):1-6.
• 27. Al-metwalli RR, Fallatah SM, Alghamdi TM. Endotracheal tube cuff pressure: An overlooked risk. Anaesthesia, Pain & Intensive Care. 2021;25(1):88-97.
• 28. Brown C, Jaiven H, Hranchook A. Implementation of a volume-based technique for endotracheal tube cuff inflation: A quality improvement project. Journal of Doctoral Nursing Practice. 2025.
• 29. Budak Ertürk E, Çevik B, Kılıç G, Çelikates N, Fulser B. The effect of perceptions of evidence-based practice on endotracheal cuff pressure management in critical care nurses: A correlational cross-sectional multicentre study. Journal of Clinical Nursing.2024;34(9):642-3649.
• 30. Mpasa F, van Rooyen DR, Jordan PJ, Venter D, Ham-Baloyi W T. Malawian critical care nurses' views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline. Southern African Journal of Critical Care. 2023;39(1):5-12.
• 31. Badawey EBB, Youssef IA, Abdel-baky MM, Mohamed AAM. Effect of educational program on critical care nurses' performance of cuffed endotracheal tube care using blended method. Minia Scientific Nursing Journal. 2024;15(1):81-89.
• 32. Henning J, Hindle L. The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session. African Journal of Emergency Medicine. 2024;14(3):156-160.