Effect of a Brief Educational Intervention on Endotracheal Tube Cuff Pressure

Endotracheal tube cuff pressure outside the recommended range of 20-30 cmH₂O is common in routine anesthesia practice. Over-inflation can injure the tracheal mucosa, while under-inflation increases the risk of aspiration and ventilator-associated pneumonia. This prospective, single-center, uncontrolled before-and-after study evaluates whether a brief educational intervention improves cuff pressure management in the operating room. Adult patients undergoing general anesthesia with endotracheal intubation at Marmara University Pendik Training and Research Hospital are enrolled in two consecutive periods. In both periods, cuff pressure is measured with a calibrated manometer shortly after intubation, together with the professional role and clinical experience of the provider who inflated the cuff. Between the two periods, a two-minute educational video explaining the importance of optimal cuff pressure and demonstrating manometer use is distributed to all operating room staff involved in cuff inflation, and reminder posters are placed in every operating room. The primary outcome is the proportion of cuff pressure measurements within the recommended range before versus after the intervention. The secondary outcome is the association between the cuff-inflating provider's role and experience and cuff pressure appropriateness. No change to patient care beyond the educational intervention is made.

Inclusion Criteria: * Adult patients aged 18 years or older * Elective or emergency surgery under general anaesthesia * Orotracheal intubation with a cuffed endotracheal tube * Written informed consent Exclusion Criteria: * Laparoscopic surgery (pneumoperitoneum alters cuff pressure) * Use of nitrous oxide during anaesthesia (diffusion into the cuff alters cuff pressure) * Nasotracheal intubation or use of a supraglottic airway device * Patients already intubated on arrival to the operating room