Tracheal cuff pressure change before and after the performance of nursing care

Verify the changes of endotracheal cuff pressure before and after oral hygiene, head-of-bed elevation at 0º, 30º, and 60º, change in body position, aspiration of the endotracheal tube, and in-bed bathing.

Method:

The study sample was composed of 88 patients. We performed 3,696 checks from July to September 2014.

Results:

Pressure values were analyzed in seven nursing care in the morning. Six of them were significantly altered before and after nursing procedure. In the afternoon, five of the health care provided were altered, and in the evening, only two. Most of pressure values were below recommended.

Conclusion:

There were differences before and after health care provided, showing changes in cuff pressure. In-bed bathing and head-of-bed elevation at 30º were the ones that most altered pressure values in the three working shifts. Therefore, it is necessary to measure cuff pressure at least twice per working shift, preferably after bathing.

Descriptors:
Intubation, Intratracheal; Pressure; Intensive Care Units; Nursing; Patient

Nursing care	Mean	SD	Median	p value
Before bathing	29.32	19.06	20	*<0.0001^ * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After bathing	19.37	4.16	20
Before oral hygiene	20.05	7.64	20	0.0482^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After oral hygiene	20.42	4.19	20
Before aspiration of endotracheal tube	20.35	3.93	20	0.0075^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After aspiration of endotracheal tube	19.32	3.61	9
Before head-of-bed elevation at 0°	20.53	8.14	19	0.0489^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 0°	18.72	3.40	18.5
Before head-of-bed elevation at 30°	19.00	3.58	19	0.0039^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 30°	18.19	3.62	18
Before head-of-bed elevation at 60°	18.02	3.68	18	0.9906^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 60°	19.29	4.33	17
Before change of decubitus	18.31	34.37	17	0.0005^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After change of decubitus	16.53	3.96	16

Nursing care	Mean	SD	Median	p value
Before bathing	24.89	13.83	20	0.0005^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After bathing	19.77	6.21	20
Before oral hygiene	19.79	6.05	20	0.145
After oral hygiene	19.92	3.64	20	0.145
Before aspiration of endotracheal tube	25.91	17.28	21	0.0033^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After aspiration of endotracheal tube	20.19	4.32	20
Before head-of-bed elevation at 0°	26.21	18.25	20	0.0019^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 0°	21.20	6.50	20
Before head-of-bed elevation at 30°	21.22	6.57	20	*<0.0001^ 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After head-of-bed elevation at 30°	18.96	4.63	18
Before head-of-bed elevation at 60°	19.01	4.65	18	0.2396
After head-of-bed elevation at 60°	18.48	4.45	19	0.2396
Before change of decubitus After	18.40	4.32	19	0.0013^* 8 p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
change of decubitus	17.26	4.47	17

Nursing care	Mean	SD	Median	p value
Before bathing	30.63	22.07	23	*<0.0001 ^ * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.**
After bathing	18.50	3.61	18
Before oral hygiene	18.62	4.24	18	0.2214
After oral hygiene	19.07	4.08	20	0.2214
Before aspiration of endotracheal tube	19.20	4.06	20	0.0663
After aspiration of endotracheal tube	18.88	3.74	19	0.0663
Before head-of-bed elevation at 0°	18.82	3.83	19	0.1462
After head-of-bed elevation at 0°	18.27	3.71	18	0.1462
Before head-of-bed elevation at 30°	18.46	4.06	18	0.0309^* * p values ≤ 0.05 significant generated by the Wilcoxon test; SD = Standard deviation.
After head-of-bed elevation at 30°	17.80	3.76	18
Before head-of-bed elevation at 60°	17.82	3.81	18	0.3404
After head-of-bed elevation at 60°	17.55	3.42	18	0.3404
Before change of decubitus	17.59	3.38	18	0.2189
After change of decubitus	17.02	3.37	17	0.2189

Nursing care	Cuff pressure < 25 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	56.8	68.2	53.4
After bathing	89.8	86.4	96.6
Before oral hygiene	88.6	87.5	96.6
After oral hygiene	75.0	84.1	87.5
Before aspiration of endotracheal tube	73.9	73.9	85.2
After aspiration of endotracheal tube	84.1	80.7	90.9
Before head-of-bed elevation at 0°	84.1	68.2	90.9
After head-of-bed elevation at 0°	96.6	75.0	95.5
Before head-of-bed elevation at 30°	93.2	73.9	92.0
After head-of-bed elevation at 30°	95.5	89.8	96.6
Before head-of-bed elevation at 60°	95.5	88.6	95.5
After head-of-bed elevation at 60°	90.9	90.9	97.7
Before change of decubitus	89.8	92.0	98.9
After change of decubitus	95.5	93.2	100.0
Nursing care	Cuff pressure 25-30 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	21.6	17.0	22.7
After bathing	9.1	12.5	1.1
Before oral hygiene	9.1	11.4	2,3
After oral hygiene	23.9	15.9	0.0
Before aspiration of endotracheal tube	26.1	18.2	0.0
After aspiration of endotracheal tube	15.9	17.0	0.0
Before head-of-bed elevation at 0°	12.5	15.9	0.0
After head-of-bed elevation at 0°	3.4	17.0	0.0
Before head-of-bed elevation at 30°	6.8	18.2	0.0
After head-of-bed elevation at 30°	4.5	8.0	1.1
Before head-of-bed elevation at 60°	4.5	9.1	1.1
After head-of-bed elevation at 60°	9.1	9.1	0.0
Before change of decubitus	10.2	8.0	0.0
After change of decubitus	4.5	5.7	0.0
Nursing care	Cuff pressure > 30 cmH₂O: average summation
Nursing care	Morning (%)	Afternoon (%)	Night (%)
Before bathing	21.6	1.1	22.7
After bathing	1.1	1.1	1.1
Before oral hygiene	2.3	1.1	2.3
After oral hygiene	1.1	0.0	0.0
Before aspiration of endotracheal tube	0.0	8.0	0.0
After aspiration of endotracheal tube	0.0	2.3	0.0
Before head-of-bed elevation at 0°	3.4	15.9	0.0
After head-of-bed elevation at 0°	0.0	8.0	0.0
Before head-of-bed elevation at 30°	0.0	8.0	0.0
After head-of-bed elevation at 30°	0.0	2.3	1.1
Before head-of-bed elevation at 60°	0.0	2.3	1.1
After head-of-bed elevation at 60°	0.0	0.0	0.0
Before change of decubitus	0.0	0.0	0.0
After change of decubitus	0.0	1.1	0.0

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[1] CORRESPONDING AUTHOR Lúcia Marinilza Beccaria Email: lucia@famerp.br