Abstract
INTRODUCTION: Inflating endotracheal tube cuffs using water instead of air before hyperbaric oxygen treatment (HBOT) is common. The objective of this study was to assess cuff pressure (P(cuff)), when the cuff was inflated using water, in normobaric conditions and during HBOT. METHODS: This was a prospective, observational study taking place in hyperbaric centre and intensive care unit of the University Hospital of Lille. Every patient who required tracheal intubation and HBOT at 253.3 kPa (2.5 atmospheres absolute [atm abs]) was included. P(cuff) was measured using a pressure transductor connected to the cuff inflating port. Measurements were performed at 'normobaria' (1 atm abs) and during HBOT at 2.5 atm abs. RESULTS: Thirty patients were included between February and April 2016. Recordings were analysable in 27 patients. Mean P(cuff) at normobaria was 60.8 (SD 42) cmH(2)O. Nineteen (70%) of patients had an excessive P(cuff) (higher than 30 cmH(2)O). Coefficient of variation was 69%. Mean P(cuff) at 2.5 atm abs was 51.6 (40.7) cmH(2)O, significantly lower than at normobaria (P < 0.0001). Coefficient of variation was 79%. In only five (18%) patients was P(cuff) < 20 cmH(2)O at 2.5 atm abs. CONCLUSIONS: In normobaric conditions, when the cuff was inflated using water and not specifically controlled P(cuff) was not predictable. The cuff was typically over-inflated exceeding safe pressure. During HBOT P(cuff) decreased slightly.