Monitoring cuff pressure

An inflated cuffed tube may be required to protect the airway from oral secretions, gastric contents or to provide a seal for adequate artificial ventilation. Managing the cuff of the tracheostomy tube is important in preventing the side effects of over-inflating or under-inflating the cuff. 

A high cuff pressure can lead to damage to the tracheal wall. The tracheal occlusion pressure is 30cmH20. The ideal cuff pressure should not exceed 20-25 cmH2O. Such high pressures prevent the delivery of oxygen to the small capillaries supplying the tracheal mucosa, resulting in ischaemia and necrosis.

Complications of cuff over-inflation include:

• Tracheal stenosis

• Tracheomalacia

• Tracheo-esophageal fistula

Complications of under inflation include:

• Micro aspiration of secretions

• Cuff leaks

The video below demonstrates how to correctly measure cuff pressure: