Efficacy of the Minimal Leak Technique of Cuff Inflation in Maintaining Proper Intracuff Pressures for Patients with Cuffed Artificial Airways

Abstract

The minimal leak technique (MLT) of cuff inflation protects against high intracuff pressures (IP) in patients intubated with high-pressure, low-volume cuffed tubes. To evaluate MLT for efficacy with high-volume, low-pressure (HVLP) cuffed tubes, 193 measurements of IP were made in 101 intubated patients. IP measurements were divided into Group 1 (≤25 cm H2O) and Group 2 (>25 cm H2O). Group 1 consisted of 53.4% of all measurements. The mean IP of 23.1 ± 2.4 cm H2O suggests that the IPs were in the safe range. Group 2 consisted of 46.6% of the total measurements. Group 2A, 22.3% of the total measurements, had a mean IP of 37.4 ± 10.0 cm H2O that could not be corrected to a safe range by use of MLT. Group 2B, 24.3% of the total measurements, had a mean IP of 35.2 ± 9.9 cm H2O that could be corrected to a mean of 23.3 ± 2.2 with MLT, indicating that MLT was not correctly employed initially for this group. The mean static airway pressure of lung and thorax was 20.6 ± 4.3 cm H2O in Group 1, 30.4 ± 13.0 cm H2O in Group 2A, and 21.5 ± 5.1 cm H2O in Group 2B (P<0.001). The use of HVLP cuffs and varying cuff inflation techniques produced safe IPs 53.4% of the time, while the remaining 46.6% of IP measurements were elevated. Use of MLT reduced IP to a safe range for 24% of the initially elevated measurements. Patients requiring higher airway pressures for ventilation may not be protected by the MLT. (Off D, Braun SR, Tompkins B, Bush G. Efficacy of the Minimal Leak Technique of Cuff Inflation in Maintaining Proper Intracuff Pressures for Patients with Cuffed Artificial Airways. Respir Care 1983;28:1115-1120.