Adjustment of intracuff pressure to prevent aspiration

Abstract

Endotracheal tubes with large-diameter, thin-walled cuffs should be used whenever possible. When a reservoir-type inflation pressure-regulating valve is not used in the operating room, the cuff should be filled with anesthetic gases injected simultaneously into the cuff and a pressure manometer as described by Lewis et al. Controlling intracuff pressures in large-diameter thin-walled cuffs between 25 and 34 cmH2O should prevent significant aspiration and still allow adequate capillary mucosal blood flow. This can be done with a pressure-regulating valve or by periodically measuring intracuff pressure and adjusting intracuff volume and pressure through a three-way stopcock.