Best evidence statement (BESt). Tracheal cuff pressure management.
General
Guideline Title
Best evidence statement (BESt). Tracheal cuff pressure management.
Bibliographic Source(s)
- Cincinnati Children’s Hospital Medical Center. Best evidence statement (BESt). Tracheal cuff pressure management. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2013 Apr 1. 4 p. [10 references]
Guideline Status
This is the current release of the guideline.
Recommendations
Major Recommendations
The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the “Major Recommendations” field.
It is recommended that cuff pressure be measured in the neonatal and pediatric population.
Note 1 : There are no studies that compare any one of these measurement approaches to another in neonates and pediatrics therefore one approach over another cannot be recommended. Research among the neonatal and pediatric populations would prove beneficial.
Note 2 : At Cincinnati Children’s Hospital Medical Center (CCHMC), current policy is to utilize minimal occlusive volume (MOV) and measure pressures with a cuff manometer, at least once per shift.
Definitions:
Table of Evidence Levels
| Quality Level | Definition |
|---|---|
| 1a† or 1b† | Systematic review, meta-analysis, or meta-synthesis of multiple studies |
| 2a or 2b | Best study design for domain |
| 3a or 3b | Fair study design for domain |
| 4a or 4b | Weak study design for domain |
| 5a or 5b | General review, expert opinion, case report, consensus report, or guideline |
| 5 | Local Consensus |
†a = good quality study; b = lesser quality study
Table of Recommendation Strength
| Strength | Definition |
|---|---|
|
It is strongly recommended that…
It is strongly recommended that… not… |
When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens. (or visa-versa for negative recommendations) |
|
It is recommended that…
It is recommended that… not… |
When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens. |
| There is insufficient evidence and a lack of consensus to make a recommendation… | |
Note : See the original guideline document for the dimensions used for judging the strength of the recommendation.
Clinical Algorithm(s)
None provided
Scope
Disease/Condition(s)
Diseases and conditions requiring cuffed endotracheal tubes or cuffed tracheostomy tubes
Guideline Category
- Management
Clinical Specialty
- Anesthesiology
- Internal Medicine
- Pediatrics
- Pulmonary Medicine
Intended Users
- Advanced Practice Nurses
- Nurses
- Physician Assistants
- Physicians
Guideline Objective(s)
To evaluate, in pediatric patients with cuffed endotracheal or tracheostomy tubes, if minimal leak technique (MLT)/minimal occlusive volume (MOV) technique compared to using a cuff manometer is a more effective way to measure cuff pressures
Target Population
Neonatal and pediatric patients with a cuffed endotracheal tube or cuffed tracheostomy tube
Interventions and Practices Considered
- Tracheal cuff pressure measurement (cuff manometer)
- Minimal leak technique (MLT)/minimal occlusive volume (MOV) technique
Major Outcomes Considered
Effectiveness of measuring cuff pressures
Methodology
Methods Used to Collect/Select the Evidence
- Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Search Strategy
- Databases : Medline, CINAHL, Google Scholar
- Search Terms : Cuff pressures, endotracheal tubes, tracheostomy tubes, minimal leak technique, minimal occlusive volume
- Limits, Filters, Search Dates : Neonatal, Pediatric; 2001-2009
- Date Search Done : April 2012-August 2012
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
- Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Table of Evidence Levels
| Quality Level | Definition |
|---|---|
| 1a† or 1b† | Systematic review, meta-analysis, or meta-synthesis of multiple studies |
| 2a or 2b | Best study design for domain |
| 3a or 3b | Fair study design for domain |
| 4a or 4b | Weak study design for domain |
| 5a or 5b | General review, expert opinion, case report, consensus report, or guideline |
| 5 | Local Consensus |
†a = good quality study; b = lesser quality study
Methods Used to Analyze the Evidence
- Systematic Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
- Expert Consensus
Description of Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Table of Recommendation Strength
| Strength | Definition |
|---|---|
| It is strongly recommended that… It is strongly recommended that… not… | When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens. (or visa-versa for negative recommendations) |
| It is recommended that… It is recommended that… not… | When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens. |
| There is insufficient evidence and a lack of consensus to make a recommendation… |
Note : See the original guideline document for the dimensions used for judging the strength of the recommendation.
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
- Peer Review
Description of Method of Guideline Validation
This Best Evidence Statement has been reviewed against quality criteria by 2 independent reviewers from the Cincinnati Children’s Hospital Medical Center (CCHMC) Evidence Collaboration.
Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation (see the “Major Recommendations” field).
Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
- Improved effectiveness of measurement of cuff pressures
- Decreased risk of tracheal wall damage, decompensation due to inadequate ventilation, and/or aspiration
Potential Harms
If cuff is over distended tracheal damage can occur and if cuff is underinflated inadequate ventilation can occur and/or aspiration.
Qualifying Statements
Qualifying Statements
This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.
Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
- Audit Criteria/Indicators
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
- Getting Better
IOM Domain
- Effectiveness
- Patient-centeredness
Identifying Information and Availability
Bibliographic Source(s)
- Cincinnati Children’s Hospital Medical Center. Best evidence statement (BESt). Tracheal cuff pressure management. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2013 Apr 1. 4 p. [10 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Date Released
2013 Apr 1
Guideline Developer(s)
- Cincinnati Children’s Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding
Cincinnati Children’s Hospital Medical Center
Guideline Committee
Not stated
Composition of Group That Authored the Guideline
Team Leader/Author : Jessica Sexton, BHS, RRT-NPS, Transitional Care Center & Neonatal Intensive Care Unit
Team Members/Co-Authors : Tonie Perez, BHS, RRT-NPS, Neonatal Intensive Care Unit; Amy Wolf, BS, RRT-NPS, Transport
Support/Consultant : Cyndi White, MSc, RRT-NPS, FAARC, Research Respiratory Therapist
Financial Disclosures/Conflicts of Interest
Conflict of interest declaration forms are filed with the Cincinnati Children’s Hospital Medical Center Evidence-based Decision Making (CCHMC EBDM) group. No financial or intellectual conflicts of interest were found.
Guideline Status
This is the current release of the guideline.
Guideline Availability
Available from the Cincinnati Children’s Hospital Medical Web site.
Availability of Companion Documents
The following are available:
- Judging the strength of a recommendation. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2008 Jan. 1 p. Available from the Cincinnati Children’s Hospital Medical Center.
- Grading a body of evidence to answer a clinical question. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 1 p.
- Table of evidence levels. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2008 Feb 29. 1 p. Available from the Cincinnati Children’s Hospital Medical Center.
In addition, suggested process or outcome measures are available in the original guideline document.
Patient Resources
None available
NGC Status
This NGC summary was completed by ECRI Institute on May 23, 2013.
Copyright Statement
This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:
Copies of this Cincinnati Children’s Hospital Medical Center (CCHMC) Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:
- Copies may be provided to anyone involved in the organization’s process for developing and implementing evidence based care
- Hyperlinks to the CCHMC website may be placed on the organization’s website
- The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
- Copies may be provided to patients and the clinicians who manage their care
Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.
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