Failure of a high compliance low pressure cuff to prevent aspiration

Abstract

Tracheal intubation with a cuffed tube permits effective positive pressure ventilation and protects the lungs from aspiraton. Ulceration of the tracheal wall, occasionally with hemorrhage or perforation, can occur with time when cuffs are inflated so that appreciable pressure is applied to surrounding tissues. Tubes sheated with high volume cuffs have been recently introduced. With these cuffs, a seal can be created at low internal cuff pressure, minimizing the pressure that can be transmitted to tracheal mucosa. This case report and supporting experimental observations indicate that large volume cuffs, while affording an effective seal for positive pressure ventilation, may not protect against aspiration in the spontaneously breathing patient.