الفهرس 
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Abstract
Cuff pressure measurement is essential in the ETT management. It is recommended that the cuff pressure should be between 20 to 30 cmH2 O. Inflation of the cuff more than 30 cm H2 O will damage the tracheal mucosa by compromising the capillary perfusion. On the other hand, Sub inflation of the cuff under 20 cm H2 O put the patients at risk for micro aspiration of subglottic secretions. In intubated and mechanically ventilated patients prolonged bed rest is common, and therapeutic positioning is very important to prevent further complications and to improve patient outcomes. Hence, CCNs should change the patient’s position every two hours to prevent complications of immobility.
It was found that changes in the patient’s body position resulted in significant increase in the ETT cuff pressure. Therefore, it is recommended to measure the ETT cuff pressure after changing patients’ body position to avoid occurrence of complications resulted from improper ETT cuff pressure.
Aim of the study:
This study was conducted to identify the relationship between body position and ETT cuff pressures among critically ill patients.
Materials and method:
To fulfill the aim of this study a descriptive research design was used to conduct this study. This study was carried out in the following two ICUs, ICU Damanhur Medical National Institute, and Damanhur Chest Hospital.
A sample of 75 adult newly orally intubated critically ill patients of both sex were included in this study according to the inclusion and exclusion criteria.
To accomplish the aim of the current study; one tool was used for data collection ”Endotracheal tube cuff pressure measurement record” which included two parts. Part I covered patients’ sociodemographic data including; age, sex, unit, date of ICU admission, date of intubation, cause for intubation, diagnosis on admission, past medical history, BMI and RASS level. The second part used to record ETT cuff pressure measurements, hemodynamic parameters, respiratory parameters and ventilator parameters at different timing before and after patients’ different body positions changes.
Data collection as the following:
First, the patients sociodemographic data were recorded in part one of the study tool.
The patients’ hemodynamic parameters, ventilator parameters, respiratory parameters and the ETT cuff pressure measurements were obtained at different timing after different body position change and recorded in the tool part II as following; before patients position changes (baseline measurement) and after patients’ body position change (immediately after, 15 minute, 30 minute, 1 hour and 2 hours after).
Results:
The age of 65.3 % of the studied patients were ranged between 51- 60 years; 62.7% were males; 34.7% had respiratory disorders followed by neurological disorders 29.3% , then cardiovascular disorders 9.9%; 64.7% were overweight, while 20% of them were obese; and 44% of the were sedated.
Results of the current study indicated that the ETT cuff pressure measurements significantly increased above the baseline measurement at different timing (immediately, 15 minutes, 30 minutes, 1hour and 2hours after changing studied patients’ body position change (semi fowler 300, right and left lateral). Moreover, the ETT cuff pressure measurements were noted to be decreased below the baseline measurements after 1hour and 2houre from changing studied patients’ body position to left lateral.
On the other hand, it was noted that there was no significant relation between the ETT cuff pressure measurements for the sedated and non -sedated patients at different time after different patients’ body position change (semi fowler position 300, right lateral and left lateral position).
Conclusion:
• The cuff pressure measurements were significantly changed with changing the patients’ body position at different timing.
• The highest ETT cuff pressure value was found to be in the right lateral position at the different timing after changing patients’ body position.
- There was a statistical significant relationship between ETT cuff pressure measurements and the patients’ characteristics at different timing from body position change.
- There was no statistical significant relationship between the ETT cuff pressure measurements for the sedated and non-sedated at different timing from body position change.
Recommendations:
• Monitoring the ETT cuff pressure is mandatory before and after critically ill patients’ body position change.
• Measuring the ETT cuff pressure using the ETT cuff manometer is recommended
• Conducting educational program for the ICU nurses to indicate the importance of the ETT cuff pressure measurement after patients’ position change.
• Focusing on the relationship between the ETT cuff pressure measurements and the patient’s position change to prevent the complications of improper cuff pressure.
• Developing a protocol for the ETT cuff pressure measurement for intubated and mechanically ventilated patients.