Synchronized intermittent mandatory insufflation of the endotracheal tube cuff.

Continuous inflation of endotracheal tube cuffs causes tracheal injury in up to 11% of intubated patients. To avoid this complication and its consequences of tracheal and laryngeal stenosis and tracheoesophageal fistula, we designed a simple device which enables intermittent inflation of the cuff during inspiratory periods of mechanical ventilation. This was achieved by connecting the inlet of the cuff of the pressure regulating tubing of the expiratory valve of a Bennett respirator. We have used the device in 25 patients with prolonged intubation. There was no air leak around the tube, no aspiration of gastric content, and no late complications as shown by direct laryngoscopy at 1 week, 1 month, and 3 months after extubation, and by X-ray of the upper airway.