Endotracheal tube (ETT) cuff pressure management is an essential
part of airway management in intubated and mechanically ventilated
patients. The ETT cuff should be inflated in order to seal the airway
without volume loss or pharyngeal content aspiration. However,
the pressure exerted on the trachea must be maintained within a
therapeutic range (25 - 30 cmH2O or 18 - 22 mmHg) that is high
enough to ensure delivery of mechanical ventilation and prevention
of marked aspiration, but low enough to ensure perfusion to the
tracheal capillaries without causing injury.1,2
Potential injuries from cuff over-inflation include tracheal rupture,
necrosis and stenosis, trachea-oesophageal fistula, and recurrent
laryngeal nerve palsy. More commonly, over-inflation can result
in stridor and a sore throat after extubation.1 Under-inflation
can lead to bronchial aspiration of secretions, particularly during
inspiration. Importantly, aspiration of pharyngeal secretions has
been associated with ventilator-associated pneumonia.3 Tracheal
stenosis often develops weeks to months after the patient has
undergone mechanical ventilation and may produce no symptoms
until the lumen has been reduced by 50 - 75%.4 The condition has
been confirmed in mechanically ventilated patients as a complication
related to over-inflated cuffs.5,6 Apart from maintaining correct cuff
pressure, it is important to perform cuff pressure measurements at
6 - 12-hourly intervals and to use the correct method.