Determinants of Tracheal Injury by Cuffed Tracheostomy Tubes

Tracheal injury continues to be a major complication of the use of cuffed endotracheal/tracheostomy tubes. To assess the determinants of such injury, 22 dogs were studied. It was found that the degree of tracheal injury induced by high compliance-low pressure tracheal cuffs was substantially less than that provoked by low compliance-high pressure cuffs. Marked compromise of tracheal arterial circulation by the high pressure cuffs was demonstrated by vascular injection studies. Tantalum tracheography was useful in assessing the presence of cuff-induced mucosal injury and in delineating tracheal distortion induced by the cuffs. Comparing the cuff compliance (pressure-volume) curve obtained outside the trachea with that obtained inside the trachea can provide a reasonable guide to cuff suitability in terms of the pressure it will apply to the trachea waff. Intercurrent hypotension or the use of positive-pressure ventilation had no discernible influence on extent of tracheal injury. It is cmicluded that high compliance-low pressure cuffs should be used exclusively in clinical practice.