We conducted an observational study to measure tracheal tube cuff pressures in the critical care environment, where prolonged intubation is common. Thirty-two patients were studied. Sixty-two per cent of all tracheal cuffs had intracuff pressures above the recommended value. We also conducted a telephone survey of 24 intensive care units within the Northern and Yorkshire Region, which showed that 75% of the intensive care units never checked tracheal tube cuff pressures. Critically ill patients are particularly vulnerable to tracheal injury due to prolonged intubation. We suggest that cuff pressures should be measured regularly.