Endotracheal Tube Cuff Leak Causes and Management

Laryngeal Pathology Context

• Laryngeal edema from prolonged intubation (>36 hours) causes reduced air leak around the deflated cuff during cuff leak testing, which predicts post-extubation stridor, as reported by the American Thoracic Society 1, 2, 3
• This represents airway pathology rather than ETT malfunction, according to the American Society of Anesthesiologists 4

Cuff Pressure Management

• The American Association for Respiratory Care recommends maintaining proper cuff pressures of 20-30 cmH₂O using cuff manometry, as relying solely on the minimal leak test is unreliable 5