The investigation of initial endotracheal tube cuff pressures in the operating room: a multi-center cross-sectional study in China

Cuffed endotracheal tubes (ETTs) are widely used in general anesthesia, with recommended cuff pressure (CP) between 20 and 30 cmH<sub>2</sub>O in adults. This multi-center study investigated actual CP management practices across 19 Grade A tertiary hospitals in China, involving 2058 anesthetized patients. The median initial CP measured within 30 min post-intubation was 48 cmH<sub>2</sub>O (IQR 32-70), with only 19% within the recommended range (75.4% > 30 cmH<sub>2</sub>O; 5.6% < 20 cmH<sub>2</sub>O). All institutions demonstrated similarly suboptimal CP management. Four distinct methods were used for cuff pressure estimation: pilot balloon palpation (96.2%), fixed-volume inflation (2.8%), minimal occlusive volume technique (0.7%), and direct manometry (0.2%). Among them, only direct manometry demonstrated reliable accuracy in achieving appropriate pressures. The remaining three methods showed no clear superiority over one another in terms of pressure assessment accuracy. In orotracheally intubated patients with palpation-estimated CP, independent risk factors for elevated pressure (> 30 cmH<sub>2</sub>O) included: age < 60 years, pressure-controlled ventilation, absence of PEEP, ETT internal diameter < 7.0 mm, aminosteroid neuromuscular blocker use, and trainee-performed inflation. These findings highlight widespread challenges in optimal CP management across Chinese tertiary care centers.

Authors

Institutions

Publication Details

Journal
Scientific Reports
Published
2026-02-01
DOI
https://doi.org/10.1038/s41598-026-37279-3
Primary Topic
Airway Management and Intubation Techniques
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

The investigation of initial endotracheal tube cuff pressures in the operating room: a multi-center cross-sectional study in China

Lulong Bo, Kaiming Duan, Wei Zhang, Mao Zhou et al.
Scientific Reports
Airway Management and Intubation Techniques
article

The investigation of initial endotracheal tube cuff pressures in the operating room: a multi-center cross-sectional study in China

Lulong Bo, Kaiming Duan, Wei Zhang, Mao Zhou, Zhaohui Tang, Qulian Guo, Yingqi Weng, Peng Wu, Xuezheng Zhang, Yilin Zheng, Hui Wang, Hongmei Ma, Gang Chen, Jiaxin Tian, Yajuan Han, Jun Xu, Heqi Peng, Jianqiang Guan, Hong Zheng, Yuekun Shen, Xiaohua Zou, Yalin Li, Shu Zheng, Wangyuan Zou, Jianliang Sun
article en

Abstract

Cuffed endotracheal tubes (ETTs) are widely used in general anesthesia, with recommended cuff pressure (CP) between 20 and 30 cmH<sub>2</sub>O in adults. This multi-center study investigated actual CP management practices across 19 Grade A tertiary hospitals in China, involving 2058 anesthetized patients. The median initial CP measured within 30 min post-intubation was 48 cmH<sub>2</sub>O (IQR 32-70), with only 19% within the recommended range (75.4% > 30 cmH<sub>2</sub>O; 5.6% < 20 cmH<sub>2</sub>O). All institutions demonstrated similarly suboptimal CP management. Four distinct methods were used for cuff pressure estimation: pilot balloon palpation (96.2%), fixed-volume inflation (2.8%), minimal occlusive volume technique (0.7%), and direct manometry (0.2%). Among them, only direct manometry demonstrated reliable accuracy in achieving appropriate pressures. The remaining three methods showed no clear superiority over one another in terms of pressure assessment accuracy. In orotracheally intubated patients with palpation-estimated CP, independent risk factors for elevated pressure (> 30 cmH<sub>2</sub>O) included: age < 60 years, pressure-controlled ventilation, absence of PEEP, ETT internal diameter < 7.0 mm, aminosteroid neuromuscular blocker use, and trainee-performed inflation. These findings highlight widespread challenges in optimal CP management across Chinese tertiary care centers.

Scientific ReportsVol. 16(1)
Hebei Medical University (CN), Fujian Medical University (CN), Central South University (CN), Guiyang Medical University (CN), Army Medical University (CN), Sun Yat-sen University (CN), Second Military Medical University (CN), Dalian Medical University (CN), Peking University (CN), Wenzhou Medical University (CN), First Affiliated Hospital of Wenzhou Medical University (CN), Sir Run Run Shaw Hospital (CN), Zhengzhou University (CN), Daping Hospital (CN), Sun Yat-sen Memorial Hospital (CN), Second Affiliated Hospital of Dalian Medical University (CN), Fourth Hospital of Hebei Medical University (CN), Affiliated Hospital of Guizhou Medical University (CN), Changhai Hospital (CN), Jiangxi Pingxiang People's Hospital (CN), National Clinical Research (US), The First Affiliated Hospital, Sun Yat-sen University (CN), Peking University First Hospital (CN), Henan Provincial People's Hospital (CN), Tianjin Hospital (CN), Fujian Provincial Hospital (CN), Third Affiliated Hospital of Sun Yat-sen University (CN), Affiliated Hangzhou First People's Hospital, Westlake University, School of Medicine (CN), Qinghai Provincial Peoples Hospital (CN), Second Xiangya Hospital of Central South University (CN), Third Xiangya Hospital (CN), Xiangya Hospital Central South University (CN), Zhejiang University (CN)
National Natural Science Foundation of China
Openalex Percentile: Top 68%
Airway Management and Intubation Techniques
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.