Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Jul 27, 2015; 4(2): 10-12
Published online Jul 27, 2015. doi: 10.5313/wja.v4.i2.10
Critical importance of tracheal tube cuff pressure management
Taoyuan Robert Feng, Ying Ye, D John Doyle
Taoyuan Robert Feng, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
Ying Ye, Cleveland Clinic, Cleveland, OH 44195, United States
D John Doyle, Department of General Anesthesia, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. D John Doyle, MD, PhD, Chief, Department of General Anesthesia, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates. djdoyle@hotmail.com
Telephone: +971-52-6997627 Fax: +971-2-4108374
Received: January 25, 2015
Peer-review started: January 30, 2015
First decision: April 10, 2015
Revised: April 29, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: July 27, 2015
Processing time: 182 Days and 13.5 Hours
Abstract

The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importance of tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations.

Keywords: Tracheal tube cuff pressure; Tracheal injury; Tracheal stenosis; Patient safety; Intubation

Core tip: The ideal range for tracheal tube cuff pressures is typically between 20 to 30 cm H2O and is easily measured with a cuff pressure manometer. The importance of tracheal tube cuff pressures is highlighted by the spectrum of complications that can occur: high cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture, while cuff pressures that are too low place the patient at risk for aspiration and consequently, aspiration pneumonitis and pneumonia.