Originally published on May 21, 2011
Respiratory therapist, S.S., asks, “If the patient has been weaned from the ventilator, should the cuff be inflated or deflated?
Answer: The inflated cuff provides a seal of the airway in order to effectively ventilate and oxygenate the patient. When the patient no longer requires the ventilator, it is usually best to deflate the cuff because of other problems that an inflated cuff can cause (tracheomalacia, tracheal stenosis, etc.). However, the exception to this rule is the patient who cannot protect his airway. Those who pose a risk for aspiration should have an inflated cuff because their cough and/or swallow reflex is not strong enough to prevent secretions from entering the airway.
When patients require cuff inflation, we need to ensure that the cuff is inflated enough to prevent leakage around the cuff, but not exert too much pressure against the trachea. Measured cuff pressure should be in the range of 20-25 cm H2O.
In the absence of measured cuff pressure, a good clinical technique is minimal leak technique. In this case the cuff is completely deflated (first, use a soft suction catheter to remove secretions from the oropharynx), then inflated until a leak is no longer heard. At that point, 1/2 ml of air is withdrawn from the cuff, enough to seal the airway, but minimizing excess pressure against the trachea.
It is important to note that clinical opinion varies on this point. If the patient is in the ICU and managed by the critical care team, their goal is to ventilate the patient and may not be as concerned with high cuff pressures in the short term. However, to prevent more long term complications, it is wise to minimize cuff pressure as much as clinically warranted.