Monitoring Tracheal Tube Cuff Pressures in the ICU Can Prevent Injury

Continuous pressure monitoring and readjustment devices are in development. “The most promising development is new endotracheal and tracheotomy tubes with polyurethane foam cuffs which self-inflate to very low pressures, while still protecting against leakage of secretions,” said Dr. Morris. “We assume, although it hasn’t been studied, that these foam cuffs are less likely to injure the trachea.”

There are also endotracheal tube cuffs that have been designed with pressure relief valves that activate at 40 cm H₂O. These self-regulating cuffs would be useful in limiting inadvertent overinflation, as well as intraoperative pressure increases with nitrous oxide.

“The main attraction of these technologies is that they would not require constant human intervention to maintain the cuff pressures, which is the main obstacle,” said Dr. Morris, “but unfortunately, they are not widely available right now.”

Until the technology arrives, “our role as airway specialists is to not only to diagnose and treat, but also to try to prevent this problem by developing hospital-wide respiratory care protocols, optimising tracheotomy care and educating other health care professionals about the risk factors of overinflated tracheal tube cuffs.”

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