Minimal occlusive volume cuff inflation: A survey of current practice

Summary 

Objective

To describe the minimal occlusive volume (MOV) procedure used to monitor cuff inflation and identify practice variation.

Research methodology

Self-administered questionnaire.

Setting

Adult intensive care unit in an Australian university-affiliated hospital.

Results

Survey response was 71% (80/113). Three methods of MOV were identified. Full cuff deflation, followed by reinflation, removal of 1mL increments of air until a leak was detected, then restoration of cuff seal with 1mL of air was the preferred method (47/80 respondents, 59%) (Method 1). Full cuff deflation followed by incremental addition of air until the MOV was established was used by 25/80 (31%) respondents (Method 2). Two (2.5%) nurses established MOV without full cuff deflation (Method 3), five (6.25%) used more than one method and one (1.25%) nurse did not perform cuff checks. Practice variation was identified for patient positioning, confirmation of cuff seal, and cuff leak management. Consistency of practice was noted in MOV procedure frequency, the number of nurses required, pre-oxygenation and oropharyngeal suctioning prior to cuff deflation.

Conclusion

Substantial practice variation for certain aspects of cuff management was noted. Evidence to support the efficacy of MOV procedural elements is required to limit practice variation and reduce risk to patients.

Keywords: Endotracheal intubation, Mechanical ventilation, Ventilator associated pneumonia, Cuff inflation, Minimal occlusive volume