Herniation of tracheal tube cuffs: a simple teaching model

Abstract

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Measuring endotracheal tube intracuff pressure: no room for complacency

“…Kao et al [38] reported hyperinflation of ETT cuff resulting in the herniation of the cuff balloon in front of the tube's end, potentially blocking gas exchange during the creation of tracheal stoma. Wright and Baruch [39] observed a situation where there was a leak due to the herniation of large-volume and low-pressure cuffed ETT when more and more air was injected into the cuff. In this situation, the cuff herniated upwards through the glottis.…”

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

“…Physiologically, blood flow to the antero-lateral part of the trachea has been reported to be compromised at pressures exceeding 30 cmH 2 O and become obstructed at pressures exceeding 50 cmH 2 O 21 . Previous studies have also shown that hyperinflation of ETT cuff could result in the herniation of the cuff balloon in front of the tube’s end 22 or upwards through the glottis 23 , thereby jeopardizing gas exchange. Hence, general practice guidelines recommended a cuff inflation pressure below 30 cmH 2 O (22 mmHg) 7 .…”

Airway ultrasound to detect endotracheal tube cuff herniation

“…The cause for this can be displacement of the tube or overinflation of ETT cuff. [ 1 ] Usually, it is noticed by the sound of gas leaking around the tube or when there is a fall in tidal volume and end-tidal carbon dioxide (CO 2 ). Confirmation and repositioning of the ETT require direct laryngoscopy which has disadvantages such as stress response[ 2 ] and is difficult to perform intra-operatively, particularly if the patient is not in supine position.…”