Outer diameter and shape of paediatric tracheal tube cuffs at higher inflation pressures.

Cuffed tracheal tubes are becoming increasingly popular in paediatric anaesthesia and intensive care medicine. To avoid cuff related complications and airway morbidity, a thorough understanding of cuff volume/pressure behaviour and management is required. In this study, the outer cuff diameter and form stability of the cuff at high cuff pressure were assessed in a series of different paediatric cuffed tracheal tubes with internal diameter of between 3.0 and 5.0 mm. The main findings were that small amounts of inflated air led to a rapid increase in cuff pressure and volume and that the outer cuff diameters increased to 2-2.5 times the age-corresponding internal tracheal diameter following inadvertent syringe inflation. Careful cuff inflation under cuff pressure monitoring and/or automatic cuff pressure release is recommended in paediatric tracheal tube cuffs to prevent airway damage caused by manual inflation, pilot balloon compression and nitrous oxide diffusion.