Severe low-pressure cuff tracheal injury in burn patients

Two cases are presented of severe tracheal damage secondary to low-pressure high-volume endotracheal tube cuffs monitored carefully against over-inflation. Our patients' findings suggest that in the presence of tracheal inhalation injury or severe tracheal infection strict monitoring of pressures, though essential, does not preclude tracheal trauma from a low-pressure cuff, trauma to a degree generally ascribed only to high-pressure "stiff" cuffs. There is probably no arbitrarily safe level of cuff pressure in these patients; any amount of pressure is likely to further harm the tracheal wall and must be weighed into the risk-benefit equation for prolonged intubation.