Listen over the neck when inflating ETT cuff

This interesting study introduces a novel technique for guiding the inflation of tracheal tube cuffs to avoid excessive cuff pressures: listening with a stethoscope over the thyroid cartilage and inflating the cuff until breath sounds change from harsh to soft.

Tracheal tube cuffs are commonly inflated to pressures exceeding the recommended upper limit of 30 cmH2O. We evaluated whether a stethoscope-guided method of cuff inflation results in pressures within the recommended range. Patients were randomly assigned to receive one of two methods of cuff inflation. In the standard ‘just seal’ group, air was introduced into the tracheal cuff until the audible leak at the mouth disappeared. In the stethoscope-guided group, air was introduced into the cuff until a change from harsh to soft breath sounds occurred, whilst listening with a stethoscope bell placed over the thyroid cartilage. Twenty-five patients were recruited
to each group. The median (IQR [range]) cuff pressure in the ‘just seal’ group was 34 (28–40 [18–49]) cmH2O, and in the stethoscope-guided group was 20 (20–26 [16–28]) cmH2O,
p < 0.0001. The stethoscope-guided method of tracheal tube cuff inflation is a novel, simple technique that reliably results in acceptable tracheal cuff pressures.

Clinical evaluation of stethoscope-guided inflation of tracheal tube cuffs
Anaesthesia. 2011 Nov;66(11):1012-6

3 thoughts on “Listen over the neck when inflating ETT cuff”

  1. An interesting wee study. I was intrigued that the mean volume of air injected was the same in both groups (5.4ml) although the cuff pressures were significantly different. I suspect a lot of us put a greater amount of air in than this just “to be safe” so a good reminder to cool off on the syringe!

  2. Years ago I worked at an ICU (Royal Brisbane) where the steth method was our standard procedure for cuff inflation. Worked well, and takes out one piece of equipment – the manometer.

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