Frequent versus infrequent monitoring of endotracheal tube cuff pressures

BACKGROUND: Currently there is no accepted standard of practice for the optimal frequency of endotracheal tube cuff pressure monitoring in mechanically ventilated patients. Therefore, we conducted a study to compare infrequent endotracheal tube cuff pressure monitoring (immediately after intubation and when clinically indicated for an observed air leak or due to tube migration) with frequent endotracheal tube cuff pressure monitoring (immediately after intubation, every 8 h, and when clinically indicated). METHODS: We performed a prospective clinical trial with subjects assigned to study groups based on room assignment. The primary outcome was the occurrence of a ventilator-associated event (VAE) and was adjudicated by individuals blinded to the conduct of this study. RESULTS: We enrolled 305 subjects, with 166 (54.4%) assigned to frequent monitoring and 139 (45.6%) assigned to infrequent monitoring. The total number of endotracheal tube cuff pressure monitoring events for both groups was 1,531 versus 336, respectively. The occurrence of VAEs was infrequent and similar for both groups (3.6% vs 5.8%, P = .37). Witnessed aspiration events (0.6% vs 0%, P = .36), ventilator-associated pneumonia (0% vs 0.7%, P = .27), 30-d mortality (31.3% vs 30.2%, P = .83), and hospital length of stay (10 d [6 d, 21 d] vs 11 d [6 d, 21 d], P = .34) were also similar for both study groups. The 30-d hospital readmission rate was statistically lower for the group that received infrequent monitoring (15.1% vs 6.5%, P = .02). CONCLUSIONS: More frequent cuff pressure monitoring was not associated with any identifiable clinical outcome benefit.