During a break from the lectures at the last SOMSA one of the first issues identified was the lack of knowledge of PEEP and the absence of PEEP valves on BVMs.  Within a few weeks the paper Why we need PEEP valves on BVMs was written, edited and posted for distribution.  Our unit ordered the extremely inexpensive valves and they were distributed down to the medics.  It is now standard to be using PEEP valves and considered less-than-best practice without.

My idea with the cuff manometer is similar.  Among other topics this could potentially improve the outcome of a patient during long evacuation times.  From what I understand, a cuff manometer is used to measure the pressure of the cuff on an endotracheal tube.  This can be important when ascending in an unpressurized cabin of a non-standard air evacuation platform.  As altitude increases the cuff expands and left unchecked can cause trauma to the trachea.  A simple device could possibly be used to measure this and make adjustments at altitude and again after descending to the next long leg of the evacuation.

Knowing this I would next ask if anyone has experience using these.  I would ask a pulmonologist how important this is.  I would ask the experts at one of the 3 Air Force CSTARS training locations if any research has been done.  The University of Cincinnati presented 2 research projects this year at SOMSA and they may already have data to support this concern.  This could then be presented to the working group for recommendations specific to a prolonged field care situation.

This one of many due-outs that we owe medics.  Are there any thoughts on this?  Please comment below and read the great discussion.