| The cuff to tracheal wall pressure should be maintained at an adequate pressure to minimize aspiration, but if the pressure is too high, the blood flow to the trachea may be interrupted. This blood flow is normally about 30 mmHg, and is known as the perfusion pressure. The cuff pressure should be maintained below the perfusion pressure, or at about 20-25 mmHg maximum.
There are several ways to manage the cuff inflation in a patient with a high volume-low pressure cuff. The first technique is the minimal occluding volume technique. Using the minimal occluding volume to determine cuff inflation is performed by injection of air into the cuff of the tracheostomy tube, until there is no leak auscultated with a stethoscope at mouth, nose or neck. Any leak should disappear at full inspiration. Adequate cuff pressure is needed to prevent volume loss through the upper airway. The minimal occluding volume technique has the potential to result in complications from cuff pressure on the trachea. | | | | |
