Authors (including presenting author) :
Li CPV(1), Yuen WS(1), Lee KW(2), Poon ST(3), Ho KM(3), Tang PY(1)
Affiliation :
(1)Intensive Care Unit, North District Hospital, (2)Intensive Care Unit, Alice Ho Miu
Ling Nethersole Hospital, (3)Intensive Care Unit, Prince of Wales Hospital
Introduction :
Endotracheal tube / tracheostomy tube is a common artificial airway in adult ICU to facilitate mechanical ventilation. Appropriate cuff pressure is crucial in preventing ventilator associated events & tracheal injury, therefore, close monitoring is essential.
Manual manometer is the major mode of monitor at present, regrettably, intermittent measurements could not maintain a static tracheal pressure. Even simple changes in patients’ position may resulted in higher incidence of ventilator associated pneumonia. Introduction of automatic tracheal cuff pressure monitor offers accurate and continuous monitoring of tracheal pressure without increase nursing workload.
Objectives :
1. The tracheal cuff pressure is well maintained at 25-30 mmHg or as Doctor’s
prescription via documentation in clinical information system.
2. Reduce nursing work on maintenance of tracheal cuff pressure.
3. Reduce Ventilator Associated Events.
Methodology :
All intubated patient’s tracheal cuffs are connected to the automatic cuff pressure manometer for continuous pressure maintenance. The tracheal cuff pressure is well maintained at 25-30 mmHg or as Doctor’s prescription. A staff satisfaction survey was also conducted on the use of automatic cuff pressure manometer.
Result & Outcome :
The outcome of this project is divided into three directions:
1. Reduction of nursing workload.
2. Nurse satisfaction.
3. Reduction of ventilator associated events.
1. Continuous tracheal pressure monitoring reduces nursing work from 240 minutes per day (10 minutes per hour) to less than 3 mins once for connection of the system.
2. A staff evaluation was launched in 3 NTEC ICUs, total 163 survey collected (response rate 80%), the evaluation was focused on the accessibility and quality of performance of the automatic cuff pressure manometer, over 90% of staff supported the device is easy to use and crucial to intubated patient in ICU.
3. The overall incidence rate of ventilator associated events in three ICUs has no significant changes after the implementation of automatic cuff pressure manometer. It may due to multifactorial reasons, further studies may needed to determine the impact of continuous control of tracheal pressure on VAE incidence.
