Positional and Temporal Changes in Endotracheal Tube Cuff Pressure in Mechanically Ventilated Intensive Care Unit Patients: A Prospective Observational Study

Background:Endotracheal tube cuff pressure may fluctuate during routine intensive care unit (ICU) care despite standard monitoring.We evaluated short-term cuff pressure changes after repositioning according to measurement time, patient position, sedation level, and body mass index. Material/Methods:This prospective observational study included 103 mechanically ventilated adult ICU patients.Before repositioning, cuff pressure was adjusted to 20 to 30 cm H 2 O when necessary, and the resulting value was recorded as T0.Patients were placed in the head-elevated supine, right lateral, or left lateral position.Cuff pressure was remeasured at 1 (T1) and 5 (T2) minutes after repositioning.Repeated measurements obtained during routine positioning cycles over a 2-day period were analyzed via mixed-effects models.Results:In total, 4944 cuff pressure measurements were analyzed.Cuff pressure significantly increased over time, from 27.67 ± 2.27 cm H 2 O at T0 to 28.11 ± 2.89 cm H 2 O at T1 and 28.29 ± 3.23 cm H 2 O at T2 (P < 0.001); the absolute magnitude of change was small.No significant differences were detected among target positions (P > 0.05).Higher Richmond Agitation-Sedation Scale (RASS) scores were independently associated with increased cuff pressure (b = 0.94 cm H 2 O per 1-point increase; P < 0.001) and higher odds of out-of-range cuff pressure (odds ratio, 7.21; P < 0.001). Conclusions:Endotracheal tube cuff pressure showed statistically significant short-term changes after repositioning.Higher RASS scores were associated with greater cuff pressure variability and higher odds of out-of-range cuff pressure.Repeated cuff pressure reassessment after repositioning may be beneficial, particularly in patients with higher RASS scores or greater agitation.