{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:55:25Z","timestamp":1782755725093,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The Critical Care Department Research Fund"},{"name":"The Queen Elizabeth Hospital, King's Lynn, UK"},{"name":"Eastern Academic Health Science Network"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Endotracheal tube cuff pressures should be maintained between 20 and 30\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O to prevent the aspiration of subglottic secretions past the cuff. Guidance recommends regular monitoring of the cuff pressure, performed using a handheld manometer\/inflator. Poor technique can lead to transient deflation of the cuff, leading to the bolus aspiration of upper respiratory tract secretions, tracheal colonization and, ultimately, ventilator\u2010associated pneumonia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and objectives<\/jats:title>\n                    <jats:p>\n                      To determine whether intensive care staff transiently deflate the endotracheal tube cuff to below 20\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O during routine cuff pressure checks when using a handheld manometer\/inflator device.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was an exploratory simulation study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A sample of medical (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910) and nursing staff (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), capable of caring for a tracheally intubated patient, participated in the study on a single day. A mannequin was intubated with a standard oral endotracheal tube with the cuff pressure set at 50\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O. Participants were required to check and correct the cuff pressure to the appropriate level with a manometer. The lowest attained and the final target pressures were recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three doctors were unfamiliar with the manometer and did not attempt measurement. During cuff pressure readjustment, 59% (10\/17) of participants transiently deflated the cuff below 20\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O and then re\u2010inflated to attain the final pressure. Of these participants, four deflated the cuff pressure to 0\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O before re\u2010adjusting it back into range. Most participants, 88% (15\/17), corrected the final cuff pressure to between 20 and 30\u2009cm\u2009H\n                      <jats:sub>2<\/jats:sub>\n                      O.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Poor technique when using the manometer led to unintentional cuff deflation during routine checks. In clinical practice, this could increase the risk of pulmonary aspiration and ventilator\u2010associated pneumonia. Further research into alternatives for handheld manometers, such as automated continuous cuff pressure monitors, is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to clinical practice<\/jats:title>\n                    <jats:p>Cuff deflations can easily occur during routine cuff pressure checks. Staff should be aware of the implications of cuff deflations and seek to improve training with manometers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.12397","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T01:25:52Z","timestamp":1543800352000},"page":"83-88","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Unintentional endotracheal tube cuff deflation during routine checks: a simulation study"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8298-9232","authenticated-orcid":false,"given":"Vikesh","family":"Patel","sequence":"first","affiliation":[{"name":"University of Cambridge School of Clinical Medicine Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J","family":"Hodges","sequence":"additional","affiliation":[{"name":"The Critical Care Department, The Queen Elizabeth Hospital King's Lynn UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryanne ZA","family":"Mariyaselvam","sequence":"additional","affiliation":[{"name":"The Critical Care Department, The Queen Elizabeth Hospital King's Lynn UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Peutherer","sequence":"additional","affiliation":[{"name":"University of Cambridge School of Clinical Medicine Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J","family":"Young","sequence":"additional","affiliation":[{"name":"The Critical Care Department, The Queen Elizabeth Hospital King's Lynn UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2009.038562"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1476-0711-5-7"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"166","DOI":"10.4187\/respcare.04490166","article-title":"Laboratory evaluation of 4 brands of endotracheal tube cuff inflator","volume":"49","author":"Blanch PB","year":"2004","journal-title":"Respiratory Care"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03246"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04996"},{"key":"e_1_2_10_7_1","unstructured":"Department of Health NHS England. (2011). High Impact Intervention Care bundle to reduce ventilation\u2010association pneumonia.http:\/\/webarchive.nationalarchives.gov.uk\/20120118165100\/http:\/\/hcai.dh.gov.uk\/whatdoido\/high\u2010impact\u2010interventions\/(accessed 12\/12\/17)."},{"key":"e_1_2_10_8_1","volume-title":"Guidelines for the provision of intensive care services","author":"Faculty of Intensive Care Medicine and Intensive Care Society","year":"2016"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31825f2bba"},{"key":"e_1_2_10_10_1","volume-title":"Health Care Protocol: Prevention of Ventilator\u2010Associated Pneumonia","author":"Institute for Clinical Systems Improvement","year":"2011"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc13775"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw353"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/677144"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200906-0838OC"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1977.tb10018.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-017-0328-0"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70081-1"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000206106.65220.59"},{"key":"e_1_2_10_19_1","first-page":"14","article-title":"Use and care of an endotracheal\/tracheostomy tube cuff\u2010\u2010are intensive care unit staff adequately informed?","volume":"42","author":"Mol DA","year":"2004","journal-title":"South African Journal of Surgery"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-015-0087-3"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201104-0630OC"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.154.1.8680665"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000181731.53912.D9"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00582-2017"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-012-2750-6"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.2174\/157339812800493269"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fnicc.12397","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.12397","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.12397","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.12397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T08:00:28Z","timestamp":1775289628000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.12397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,2]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1111\/nicc.12397"],"URL":"https:\/\/doi.org\/10.1111\/nicc.12397","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,2]]},"assertion":[{"value":"2018-03-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}