Adult Critical Care Specialty (ACCS) Practice Exam

What action should be taken if a patient's endotracheal tube cuff cannot maintain pressure?

1. Monitor the patient closely

2. Replace the ET tube immediately

3. Inflate the cuff manually

4. Assess the need for surgical airway intervention

The correct answer is: Replace the ET tube immediately

When a patient's endotracheal tube (ET tube) cuff cannot maintain pressure, it’s essential to address the issue promptly to ensure effective ventilation and prevent aspiration. Replacing the ET tube immediately is the correct course of action in this situation for several reasons. If the cuff is unable to maintain pressure, it suggests a leak that could compromise the patient's airway integrity and lead to inadequate ventilation. This condition can result from a malfunctioning cuff, damage to the ET tube, or improper placement. If the cuff cannot seal properly, air can escape around the tube, which not only affects ventilation but also increases the risk of aspiration and may cause respiratory failure. While monitoring the patient closely and inflating the cuff manually might seem like temporary solutions, they do not address the underlying problem. Manual inflation may provide a short respite but doesn’t rectify the inability of the cuff to maintain pressure in the long term. Assessing the need for surgical airway intervention may also be appropriate in certain scenarios, but in the case of a failing ET tube cuff, replacing the tube is the most direct and effective response to ensure continued airway protection and ventilation. In summary, replacing the ET tube immediately is crucial for maintaining airway integrity and ensuring effective respiratory support.