Endotracheal tubes (ETTs) and tracheostomy tubes have pilot balloons which are inflated to expand a pilot cuff situated within the trachea below the vocal cords. This is termed a “secure airway.”
If this cuff is underinflated, air may leak around the tube resulting in hypoventilation for patients on mechanical ventilation and increasing the risk for aspiration of oropharyngeal secretions. Overinflation may cause the cuff to exert high pressure on the tracheal mucosa resulting in regional hypoperfusion and necrosis. This, in turn, may lead to strictures and subglottic stenosis.
A Posey Cufflator is a manometer that can be attached to the pilot balloon to measure the cuff pressure. Squeezing the inflator bulb allows the operator to add more air to the cuff, and an air vent button on the backside allows air to be released. The goal pressure range is highlighted in green (~25 cm H2O).
These days in the ICU, most modern ventilators have a way of monitoring cuff pressure directly and continuously (ie, Hamilton Medical’s IntelliCuff). This eliminates the need for a manual manometer. Devices like the Cufflator are more helpful in the OR for long operations.
Have you ever used a Posey Cufflator? Drop me a comment with your questions!