The purpose of the cuff is to provide a closed system
to allow effective ventilation and/or airway protection.
Cuff pressure should be 20 to 25 cm H2O with most tracheostomy
tubes.21,25Monitoring cuff pressure is important
because underinflation of the cuff promotes leakage
of secretions around the cuff, a situation that can contribute
to ventilator-associated pneumonia.25 However,
overinflation of the cuff can cause numerous long-term
complications, including tracheomalacia, tracheoinnominate
artery fistula, tracheal ulcerations, fibrosis, tracheal
stenosis, and tracheoesophageal fistula.21
If a leak around the cuff persists, the pilot balloon
maybe ineffective in sealing the airway or the trachea may
have lost its rigid composition. A persistent leak will be
manifested by audible noises around the tracheostomy
tube and loss of returned volumes with ventilation. For
example, if the tidal volume is set at 700 mL, and the
returned volumes
are only
500 mL, the
patient is not
getting the
benefit of the entire tidal volume. If the cuff continues to
require more air to seal the airway, the pilot balloon may
be ineffective,25 the tracheostomy tube may be too small
for the airway, or tracheomalacia may have developed