Faculty Bibliography

OBJECTIVES: Tracheal tube cuff overinflation is a recognized risk factor for tracheal injury and stenosis. International studies report a 55% to 62% incidence of cuff overinflation among intensive care unit (ICU) patients. However, there are no data on tracheotomy tubes, and no recent data from ICUs in the United States. It is unknown whether routine cuff pressure measurement is beneficial. We sought to determine the incidence of cuff overinflation in the contemporary American ICU. METHODS: We performed an Institutional Review Board-approved, prospective, observational study of endotracheal and tracheotomy tubes at 2 tertiary-care academic hospitals that monitor cuff pressure differently. At hospital A, cuff pressures are assessed by palpation; at hospital B, cuff pressures are measured via manometry. We audited cuff pressures in an unannounced fashion at these hospitals, using a handheld aneroid manometer. Cuffs were considered overinflated above 25 cm H2O. RESULTS: We enrolled 115 patients: 63 at hospital A and 52 at hospital B. Overall, 44 patients (38%) were found to have overinflated cuffs. The incidence of overinflation was identical at the 2 hospitals (38%; p = .99). Of the endotracheal tubes, 43% were overinflated, as were 32% of the tracheotomy tubes (p = .24). CONCLUSIONS: Despite increasing awareness among intensivists and respiratory therapists, the incidence of tracheal tube overinflation remains high, with both endotracheal and tracheotomy tubes. Our finding that the use of manometry to assess cuff pressures did not reduce the incidence of overinflation suggests that a more vigilant management protocol may be necessary

Disaster planning must anticipate how demands imposed by a disaster reconcile with the capacity of the treating facility. Resources must be organized before an event so that they are optimally used to treat as many victims as possible, as well as to avoid overwhelming available resources

The purpose of this report is to provide information regarding preparation for disaster management from the perspective of ICU physicians. Both a framework toward ICU preparation for disaster management and a guide to the relevant literature are presented. Our objective is to show that the understanding of disaster preparedness on multiple levels, including government, hospital, ICU, and clinician, may lead to optimal management in a disaster

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics