Risks of Placing Your Endotracheal Cuff Too High

When intubating, we all know to check the depth of the endotracheal tube (ETT). Most people believe this is just to ensure that the tube is not too deep and therefore causing a mainstem intubaton: intubating just one bronchus and therefore only one lung. However, there are significant risks with having the tube too shallow, placing the endotracheal cuff too high, and above the cords.

Endotracheal Tube Cuff Above The Cords

Illustration of endotracheal tube cuff too high and above the cords. Risk of accidental extubation is high when the cuff is above the cords.

Risk of accidental extubation is high when the cuff is above the cords.

In addition to ensuring that the tube is not too deep, also make sure that the cuff is not too high, and that it’s below the cricoid ring. Having the cuff above the cords happened to me just the other day and even I was fooled for a few minutes into thinking that I had a cuff leak. Continue reading