The decision to attempt cuff deflation should be made by appropriate members of the multidisciplinary team and carried out and monitored by appropriately trained and skilled staff.

Table 1 describes what you need to check before deflating the cuff.

The inflated cuff does allow a small amount of continuous positive airway pressure (CPAP) to be generated (with or without a ventilator). Cuff deflation can have significant effects in those with limited physiological reserve, particularly heart or breathing failure. If there has been no laryngeal airflow for a while, cuff deflation can be a shock for the larynx and cause lots of coughing and blow secretions into the mouth. Warn the patient and be prepared.

If the patient is receiving some help from a ventilator then you will need to review the settings, as the deflated cuff will allow some gas to escape via the upper airways (i.e. not all of the gas the ventilator things it is delivering to the lungs will get there).

Short trials may be required that progress to longer, continuous periods.

Fig 1 is a video demonstrating a cuff deflation trial for a patient on a ventilator. You can learn more about strategies that promote successful cuff deflation in session 6.

Table 2 lists some further practical points.