Cuff Pressure
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.21,25 Monitoring 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.31
Patient education on care of the tracheostomy tube and stoma is of utmost importance in preventing many complications.
Previous SectionNext Section