文档介绍：E REVIEW ARTICLE
CME Endotracheal Tube Cuff Leaks: Causes, Consequences,
and Management
Mohammad El-Orbany, MD* and M. Ramez Salem, MD†
The consequences of endotracheal tube (ETT) cuff leak may range from a bubbling noise to a
life-threatening ventilatory failure. Although the definitive solution is ETT replacement, this is
often neither needed nor safe to perform. Frequently, the leak is not caused by a structural
defect in the ETT. Cuff underinflation, cephalad migration of the ETT (partial tracheal extuba-
tion), misplaced orogastric or nasogastric tubes, wide discrepancy between ETT and tracheal
diameters, or increased peak airway pressure can cause leaks around intact cuffs. Correction
of these problems will stop the leak without ETT replacement. Alternatively, ETT cuff, pilot bal-
loon, and inflation system damage due to inadvertent trauma or manufacturing defects may
be responsible. Conservative management ideas (management without ETT replacement) were
previously published to solve the problem. However, when a large structural defect is identified
or conservative measures fail, ETT replacement es necessary. This can be performed
with direct laryngoscopy if laryngeal visualization is adequate. A difficult exchange with pos-
sible airway loss should be anticipated, and prepared for, when there are signs and/or history
of difficu