Tracheostomy cuff pressure monitoring is very important for any patient with a tracheostomy tube.  The goal is to find a balance between a good seal and also avoiding high cuff pressures that could cause tracheal blood flow occlusion.

Inflating the cuff volume to create enough pressure  to create a seal the trachea should be used.  The cuff seals the trachea to ward off silent cuff leaks which can lead to ventilator associated pneumonia (VAP).

Cuff Inflation Techniques

There are two techniques for inflating the tracheostomy tube cuffs with air.  They are used for different purposes.

Minimum Leak

The minimum leak technique is used when it is known that an individual has an intact swallowing and can protect their own airway yet needs the tracheostomy to bypass an upper airway obstruction or for chronic ventilation.

Minimal Occlusion

The minimal occlusion technique is for individuals who need the tracheostomy tube for airway protection.

Manometer Cuff Pressure Measurement

The most accurate way to know the pressure that the cuff is exerting on the tracheal wall is to use a cuff manometer.  The manometer measures the pressure in cmH2O.  Cuff pressures higher than 35 cmH2O can cause tracheal capillary blood flow occlusion and risk of tracheal-wall damage.  Cuff pressures between 25 to 35 cmH2O are appropriate.  The care giver should use the least amount of air possible to create a seal.

Direct Measurement of Sterile Water

If the cuff is designed for the use of sterile water (TTS style trachs), measure the amount of sterile water injected into the cuff.  During your daily tracheostomy assessment remove the sterile water from the cuff and record the amount.   Re-inject the same amount back it into the cuff.

*To further your understanding of cuff pressures use the interactive cuff inflation syringe to change the volume in the cuff and watch the pressure changes that occur as a result.