Episode 20 – Measuring Up: ETT Cuff Manometry

The vast majority of endotracheal tubes (ETT) are now cuffed. In general practice, appropriate cuff pressures are assessed by external palpation or cession of an audible leak. But is this conventional method safe? In this podcast episode, we discuss hyper and hypo-inflation, frequency of their occurrence, and how to accurately measure cuff pressures to ensure appropriate inflation.


Pressure – Volume Loop (PV-L) before and after cuff inflation:



Posey Cufflator Endotracheal Tube Inflator & Manometer:



Hamilton IntelliCuff:


Makeshift Device: 

Almarakbi, W. A., & Kaki, A. M. (2014). Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial. Saudi Journal of Anaesthesia, 8(3), 328-334. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141379/.

Annoni, R., & Almeida, A. E. (2015). Handcrafted cuff manometers do not accurately measure endotracheal tube cuff pressure. Revista Brasileira De Terapia Intensiva, 27(3), 228-234. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592116/#!po=1.25000.

Brendt, P., Schnekenburger, M., Paxton, K., Brown, A., & Mendis, K. (2012). Endotracheal Tube Cuff Pressure before, during, and after Fixed-Wing Air Medical Retrieval. Prehospital Emergency Care, 12(2), 177-180. Retrieved from https://www.tandfonline.com/doi/abs/10.3109/10903127.2012.744787.

Khan, M. U., Khokar, R., Qureshi, S., Zahrani, T. A., Aqil, M., & Shiraz, M. (2016). Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method. Saudi Journal of Anaesthesia, 10(4), 428-431. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044728/.

Tennyson, J., Ford-Webb, T., Weisberg, S., & LeBlanc, D. (2016). Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport. Western Journal of Emergency Medicine, 17(6), 721-725. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27833679.

Weisberg, S. N., McCall, J. C., Jr., & Tennyson, J. (2017). Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS. Western Journal of Emergency Medicine, 18(4), 624-629. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468068/.



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