Prediction of optimal endotracheal tube cuff volume from tracheal diameter and from patient height and age: a prospective cohort trial

J Anesth. 2012 Aug;26(4):536-40. doi: 10.1007/s00540-012-1371-0. Epub 2012 Mar 22.


Purpose: Endotracheal tube intra-cuff pressure should be maintained between 20 and 30 cmH(2)O to prevent damage to the tracheal wall. However, cuff pressure is rarely measured, and clinicians estimate cuff pressure poorly. The goal of the present study was to predict the cuff volume that produces optimal cuff pressure either from tracheal diameter or from patient height and age.

Methods: In the development phase, initial cuff pressure and cuff volume were measured in 240 patients. Optimal cuff volume, defined as the volume halfway between the volumes required to produce cuff pressures of 20 and 30 cmH(2)O, was determined in each patient. Then, regression equations relating optimal cuff volume to tracheal diameter on chest X-ray, and between optimal cuff volume and a combination of height and age, were calculated. The primary outcome was the proportion of patients in a validation set (n = 104) who achieved a cuff pressure of 20-30 cmH(2)O when cuff volume was selected by each regression formula.

Results: Only 28% of the cuffs were optimally inflated using clinical criteria during the development phase. There was good correlation between optimal cuff volume and tracheal diameter and moderate correlation between optimal cuff volume and both height and age. Predicted cuff volume was more likely to provide optimal cuff pressure when based on tracheal diameter (65% of patients) than when based on both height and age (45% of patients).

Conclusions: Optimal cuff volume was better estimated from tracheal diameter and patient height and age than from the manual palpation method.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anesthesia, General
  • Body Height / physiology*
  • Body Weight / physiology*
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Intubation, Intratracheal / methods*
  • Male
  • Manometry
  • Middle Aged
  • Predictive Value of Tests
  • Pressure
  • Radiography, Thoracic
  • Regression Analysis
  • Reproducibility of Results
  • Retrospective Studies
  • Trachea / anatomy & histology*
  • Trachea / diagnostic imaging
  • Young Adult