The therapist is performing airway care on a mechanically ventilated patient who is intubated with a Hi-Lo Evac endotracheal tube. While checking the cuff pressure, the therapist notices that pressure manometer reads 30 cm H2O, and that the vacuum pressure gauge, providing continuous suction, indicates 100 mm Hg. Inspection of the mucous collector shows that it is empty. What should the therapist

do at this time?

A. Inject 10 cm H2O into the cuff, and increase the vacuum pressure to 110 mm Hg.
B. Decrease the cuff pressure by 10 cm H2O, and leave the vacuum pressure set at 100 mm Hg.
C. Leave both the cuff pressure and vacuum pressure set at their respective levels.
D. Leave the cuff pressure at 30 cm H2O, and decrease the vacuum pressure to 70 mm Hg.

?ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The Hi-Lo Evac endotracheal tube (ETT) is designed to provide continuous subglottic suction. Studies have revealed that the removal of secretions above the cuff of an ETT reduces the incidence of early ventilator associated pneumonia. The Hi-Lo Evac ETT has a second lumen embedded in the body of the tube. This lumen opens immediately above the cuff on the posterior aspect of the ETT. Bedside care of this special tube includes:
• ? Maintaining continuous vacuum at 70 mm Hg
• ? Sustaining 25 to 30 cm H2O in the ETT cuff while checking this pressure every 4 hours
• ? Verifying lumen patency every four hours by injecting 2 to 4 ml of air via a syringe
• ? Ascertaining lumen patency if no secretions are recovered in the mucous collector
Therefore, in this question, the therapist should have left the cuff pressure undisturbed, lowered the vacuum pressure to 70 mm Hg, and corroborated lumen patency because the mucous collector was empty.