The low-pressure and low-tidal volume alarms are sounding on a mechanically ventilated patient. Measurement of the cuff pressure reveals 18 cm H2O. What action should be taken?
a. Replace the endotracheal tube with a larg-er size.
b. Add enough air to the cuff to maintain the cuff pressure at 34 cm H2O.
c. Increase the set pressure to increase the tidal volume and compensate for the leak.
d. Add air until a slight leak is heard while auscultating the larynx, then measure pressure.
ANS: D
The minimum leak technique (MLT) should be used whenever possible to avoid tracheal necrosis associated with cuff overinflation. The size of the tube and patient is not given, so one cannot say whether or not the endotracheal (ET) tube is too small. 34 cm H2O is the maximum pressure that should be in a cuff. However, since all airways are different, the most effective way to minimize the risk of tracheal problems is to use MLT.
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