Análise das pressões dos balonetes dos tubos endotraqueais de pacientes submetidos a cirurgias no centro cirúrgico do Hospital das Clínicas da Universidade Federal de Pernambuco : estudo prospectivo observacional

Inadequate control of tracheal tube cuff pressure can result in immediate or late complications, such as bronchial aspiration or tracheal injuries, which may require complex medical interventions to correct them and consequent increase in morbidity and mortality. The objective technique using a pressure gauge is the most recommended for maintaining safe pressure values (20–30 cm H₂O). But as this device is not widely available in operating rooms, health professionals, including anesthesiologists, resort to subjective techniques. The aim of this study was to evaluate the adequacy of the subjective technique for obtaining cuff pressures, knowledge of recommended pressure limits for tracheal tube cuffs and professional experience with use of pressure gauge between specialist physicians and anesthesiology residents of the same university hospital. This was a prospective observational study, conducted at the Clinical Hospital of the Federal University of Pernambuco, between March and November 2016, with participants performing tracheal intubation and subjective technique of balloon cuff inflation with syringe, followed by digital palpation. Laryngeal and tracheal anatomical abnormalities, risk of bronchoaspiration and emergency cases were not included. Within 60 minutes after intubation, an investigator recorded cuff pressure using an analogical pressure gauge (AMBU®) attached to the tube guide cuff. Data from 47 anesthesiologists were evaluated in the study — 24 residents and 23 specialists. The mean (DP) and median (IQR) pressures found in cmH₂O were 52.5 (27.1) and 50 (30–70), with minimum and maximum values of 12 and 120. Of the sample, 83% of the cuffs were outside the appropriate pressure range, with no difference between specialists and residents. Pressure correction was performed in 76.6% of cases. Knowledge of guidelines for setting appropriate pressures in this procedure and level of experience with the objective technique were also similar between the groups. We conclude that the handling of tracheal tube cuff with subjective technique of syringe insufflation and digital palpation is not efficient to guarantee the recommended pressure levels, resulting in high prevalence of inadequate pressures, with no difference in performance between specialists and residents. Their level of knowledge of the recommended minimum and maximum pressure limits for cuffs is equally low, as is their experience in using devices to perform objective techniques.