An adult man on ventilatory support has just been intubated with a 7-mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff
When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H2O. What is most likely the problem?
a. The tube chosen is too small for the pa-tient.
b. The cuff pilot balloon and line are ob-structed.
c. The tube is in the right main stem bron-chus.
d. The cuff has herniated over the tube tip.
ANS: A
High pressures may be caused by the need to overinflate the cuff to seal the airway. This problem is common if the tube chosen is too small for the patient's trachea, positioned too high in the tra-chea or if the patient has developed tracheomalacia which is softening of the tracheal tissue.
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