Effectiveness of Interventions to Increase Provider Monitoring of Endotracheal Tube and Laryngeal Mask Airway Cuff Pressures.

Previous research demonstrates that monitoring and adjusting pressures in endotracheal (ET) tubes 30 cm H2O or less and laryngeal mask airways (LMAs) 60 cm H2O or less decrease rates of postoperative pharyngolaryngeal complications. In this evidencebased practice project we examined whether a multistep intervention (departmental education plus reference cards in operating rooms plus addition of cuff pressure documentation variable in electronic anesthesia record) would increase the frequency of providers monitoring intracuff pressures and decrease the rate of high intracuff pressures. Before and after the intervention, we recorded intracuff pressures of 51 ET tubes and 51 LMAs in surgical patients, as well as providers’ self-reported incidence of monitoring and adjusting intracuff pressures. Our multistep intervention increased provider monitoring of intracuff pressures in ET tubes (77% pre- vs 94% postintervention, P = .025) and LMAs (37% pre- vs 94% postintervention, P < .001). Mean ET tube and LMA cuff pressures were significantly lower postintervention: ET tube: pre = 34 ± 16 cm H2O vs post = 29 ± 12 cm H2O (P = .045), LMA: pre = 73 ± 30 cm H2O vs post = 49 ± 15 cm H2O (P < .001). Our multistep intervention improved compliance with intracuff pressure recommendations.