How to assess the adequate amount of air in an ET tube cuff
The authors of this clinical case report describe palpating the pilot balloon to assess the pressure within the endotracheal tube cuff. This technique has been reported elsewhere and the limitations of this technique has been described (Briganti, Portela, Barsotti, Romano, & Breghi, 2012; Veen & Grauw, 2022). Perhaps more sensitive techniques such as auscultation over the larynx (Burns, 2020) or the use of mechanical ventilation (Ferreira, Allen, De Gasperi, Buhr, & Morello, 2021) would be a better alternative. The latter is based on the fact a mechanical ventilator will not cycle properly until there is an adequate seal around the endotracheal tube cuff. Spirometry is another modality that could be used for this purposed based upon this author’s clinical experience in both small and large animal practice. In small animals, I have detected differences between an unsealed and sealed endotracheal tube cuff using as little as 0.2mL of air injected into the cuff based upon the pressure-volume loop. Unfortunately, there is only one large animal anaesthetic machine that has this capability11Tafonius, Hallowell EMC, Pittsfield, MA 01201, USA. There is no current consensus on the verification of the adequacy of a seal between the ET tube cuff and tracheal wall.