Abstract
A ruptured endotracheal (ET) tube cuff is a serious complication in the critically ill patient. Because replacing the faulty tube can be dangerous, we devised a continuous-flow apparatus that can keep a faulty cuff adequately inflated until a more effective airway can be provided in a safe, controlled manner. The apparatus is constructed of commonly available hospital items. It delivers a continuous flow of blended air and oxygen to the ET-tube cuff's pilot balloon line, with flow titrated upward until the cuff leak disappears—usually at a flow of 4 to 6 L/min. A pressure-relief port protects against dangerous overpressurization of the ET-tube cuff, and a system manometer displays and monitors intracuff pressure (= tracheal wall pressure), which should be kept to levels < 25 cm H2O [2.5 kPa]. We have successfully employed this continuous-flow cuff-inflation system for up to 48 hours in critically ill patients, without encountering complications associated with its use, thus avoiding emergency extubation and 'buying time' until other airway security measures could be safely provided.
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