cuff pressure at high altitude

Q: Cuff pressure in endotracheal tube (ETT) on transporting a ventilated patient towards a higher altitude will? (select one)

A) Rise 
B) Fall


Answer: A

When a patient is transported to higher altitude for any reason, attention should be paid to cuff pressure on ETT. Cuff pressure increases when a patient is moved to a higher altitude simply because air tends to expand at higher altitude. And, this rise can be clinically significant to cause tracheal ischemia. At least one study showed that when patients were moved from sea level to a height of 3000 feet, the mean rise in cuff pressure was 23 cm H2O. 

#pulmonary
#high-altitude-medicine
#transport-medicine


References:

1. Weisberg SN, McCall JC Jr, Tennyson J. Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS. West J Emerg Med. 2017;18(4):624–629. doi:10.5811/westjem.2017.3.32078

2. Choi YS, Chae YR. Effects of rotated endotracheal tube fixation method on unplanned extubation, oral mucosa and facial skin integrity in ICU patients. J Korean Acad Nurs 2012; 42:116. 

3. Mann C, Parkinson N, Bleetman A. Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport. Emerg Med J2007;24:165–7.

4. Henning J, Sharley P, Young R. Pressures within air-filled tracheal cuffs at altitude – an in vivo study. Anaesthesia 2004;59:252–4.