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 AND METHODS This prospective observational study included 103 mechanically ventilated adult ICU patients. Before repositioning, cuff pressure was adjusted to 20 to 30 cm H₂O 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 H₂O at T0 to 28.11±2.89 cm H₂O at T1 and 28.29±3.23 cm H₂O 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 (ß=0.94 cm H2₂ 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.