Adequate sealing of the extra-luminal airway in endotracheally intubated patients is pivotal to allow efficient positive pressure ventilation and to avoid micro-aspiration of subglottic secretions into the lower respiratory tract potentially causing ventilator-associated pneumonia (VAP). On the other hand, excessive cuff pressure causes tracheal damage resulting in substantial morbidity such as fistula or stenosis formation. As such, the endotracheal cuff pressure must ensure adequate sealing while, simultaneously, avoiding compromised tracheal perfusion. In general, this objective corresponds with a cuff pressure that ranges 20 to 30 cm H2O.

In the past decades, distinct endotracheal tubes have been developed to either reduce the risk of tracheal damage or optimize sealing capacity.2–4  Despite innovative endotracheal tube designs, maintaining an optimal cuff pressure remains an Achilles heel. Indeed, endotracheal cuff pressure may decrease over time and is also influenced by...

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