An endotracheal (ET) or tracheostomy cuff provides a closed system for mechanical ventilation, allowing a desired tidal volume to be delivered to the patient’s lungs. To function properly, the cuff must exert enough pressure on the tracheal wall to seal the airway without compromising the blood supply to the tracheal mucosa.

The ideal pressure (known as minimal occlusive volume) is the lowest amount needed to seal the airway. Many authorities recommend maintaining a cuff pressure lower than venous perfusion pressure—usually about 20 to 30 mm Hg.¹ When cuff pressure is too low, oropharyngeal secretions can leak around the cuff, increasing the risk for ventilator-associated pneumonia. Overinflation of the cuff may cause tracheal necrosis, tracheomalacia, and tracheal stenosis.¹ Actual cuff pressure will vary with each patient, however. To keep pressure within safe limits, measure minimal occlusive volume at least once each shift or according to your facility’s policy. Cuff pressure can be measured by a respiratory therapist or by the nurse.