Which of the following conditions can cause the cuff pressure in an endotracheal tube to become elevated? I. too small an ETT for a given patient II. malposition of the ETT III. tracheomalacia IV. the length of the ETT

A. I, III only
B. II, IV only
C. I, II, III only
D. II, III, IV only

?ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: If the ETT migrates cephalad and lodges in the larynx, the cuff pressure will elevate, but there will probably be an air leak around the cuff. Similarly, if the ETT migrates into the right mainstem bronchus, the ETT cuff pressure will also rise.
When the internal diameter (I.D.) of an ETT is too small for a patient's trachea, a greater volume must be injected into the cuff to create a seal against the wall of the trachea. This development does not necessarily mean that the pressure against the trachea is high; however it does mean that the pressure inside the cuff is high. Therefore, choosing an appropriately sized ETT is essential for good airway care. Tracheomalacia is a condition where the trachea softens. The cartilage becomes soft and pliable. Consequently, if an ETT needs to be used in a patient with tracheomalacia, ETT cuff pressure tends to be high to create a seal.
D. Incorrect response: The length of an ETT has no bearing on the pressure inside the cuff of an ETT.