The cuff provides a 'seal' in the airway (Fig 1a).

Question: What are the advantages of a cuff?

Answer

The cuff provides a 'seal' in the airway (Fig 1a).

Question: What are the advantages of a cuff?

Answer: If the patient needs positive pressure ventilation, or any degree of pressure support for their breathing, then an inflated cuff means that gas delivered to the tube gets directed into the lungs (Fig 1b). Whilst it is possible to ventilate patients effectively with the cuff down (or without a cuff), gas will escape out via the upper airways and so not all of the delivered breath will go to the lungs. This can be useful during recovery and can allow the patients to talk.

Question: How do you think cuffs can reduce the chance of 'aspiration'?

Answer

The cuff provides a 'seal' in the airway (Fig 1a).

Question: What are the advantages of a cuff?

Answer: If the patient needs positive pressure ventilation, or any degree of pressure support for their breathing, then an inflated cuff means that gas delivered to the tube gets directed into the lungs (Fig 1b). Whilst it is possible to ventilate patients effectively with the cuff down (or without a cuff), gas will escape out via the upper airways and so not all of the delivered breath will go to the lungs. This can be useful during recovery and can allow the patients to talk.

Question: How do you think cuffs can reduce the chance of 'aspiration'?

Answer: The other main use for the inflated cuff is to offer a degree of protection against aspiration of secretions or blood from the mouth/pharynx into the airway, past the tube and into the lungs. The cuffs aren’t perfect though and ‘micro-aspiration’ can still occur (Fig 1c). Regular suctioning of subglottic secretions can help. These are special tubes with an additional port that exits above the cuff. You can remove (green) secretions by aspirating the (purple) port seen in the image.

Some systems can be connected to this port to allow intermittent or continuous suction, or even flushing of this space.

Fig 2 is a video demonstrating subglottic suction technique.

The cuff provides a 'seal' in the airway (Fig 1a).

Question: What are the advantages of a cuff?

Answer: If the patient needs positive pressure ventilation, or any degree of pressure support for their breathing, then an inflated cuff means that gas delivered to the tube gets directed into the lungs (Fig 1b). Whilst it is possible to ventilate patients effectively with the cuff down (or without a cuff), gas will escape out via the upper airways and so not all of the delivered breath will go to the lungs. This can be useful during recovery and can allow the patients to talk.

Question: How do you think cuffs can reduce the chance of 'aspiration'?

Answer: The other main use for the inflated cuff is to offer a degree of protection against aspiration of secretions or blood from the mouth/pharynx into the airway, past the tube and into the lungs. The cuffs aren’t perfect though and ‘micro-aspiration’ can still occur (Fig 1c). Regular suctioning of subglottic secretions can help. These are special tubes with an additional port that exits above the cuff. You can remove (green) secretions by aspirating the (purple) port seen in the image.

Some systems can be connected to this port to allow intermittent or continuous suction, or even flushing of this space.

Fig 2 is a video demonstrating subglottic suction technique.