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Three reasons why a cuff manager makes sense

Tracheostomy is now standard in acute care, rehabilitation and homecare. Monitoring cuff pressure is an important aspect in the care of tracheostomised patients.

Monitoring and adjusting the pressure of the cuff of tracheostomy tubes and endotracheal tubes helps to reduce the risk of ventilatory pneumonia and to reduce possible consequential damage to the trachea (e.g. mucosal necrosis, cartilage destruction, tracheomalacia). A correlation between cuff pressure management and ventilator-associated pneumonia (VAP) rates has been reported in the literature. For example, Lorente et al. show that continuous cuff pressure monitoring reduces the rate of VAP in a prospective randomised trial with more than 250 patients.
(1, 2)

There are two ways to regularly check the cuff pressure: a hand-held manometer for spot measurement or a cuff manager for continuous monitoring and control, such as the TRACOE smart Cuffmanager. 3 smart reasons that speak for themselves:


Reason No. 1: He pays attention                                                                                                        

The advantage of continuous monitoring of the cuff pressure is that the measurements are regulated throughout. There are many possible influences that change the cuff pressure - such as positioning or repositioning, the patient's tension or relaxation, or even the usual changes in air pressure. A pressure drop of 20 mbar or more can occur when a storm depression passes through. This means that an unregulated cuff pressure increases by about this value, e.g. from 25 to 45 mbar. The smart cuff manager can provide a measure of safety here: fluctuations and peaks in cuff pressure are reduced. The TRACOE smart permanently maintains the internal pressure of the high-volume low-pressure cuffs of tracheostomy tubes or endotracheal tubes between 20 and 30 mbar, the pressure range recommended by the Robert Koch Institute. (3)


Reason no. 2: He cares

If the pressure is too low, the TRACOE smart refills the cuff. An integrated damping function prevents air from immediately flowing away from the cuff to the buffer balloon, e.g. during coughing jerks.

Permanently too high cuff pressure, which could lead to tissue damage, is reduced by the smart. Edauveragne et al. show in a recent study that the addition of continuous cuff pressure measurement with the TRACOE smart cuff manager to routine manual intermittent correction reduced the frequency of episodes with too low pressure without causing overinflation. (4)


Reason No. 3: It gives you security at a glance

It makes sense to keep a distance, if possible, not least with highly infectious patients. The TRACOE smart cuff manager allows this after the initial set-up. To use the smart, it is firmly connected to the filling valve of the tracheostomy tube or the endotracheal tube by means of a connector. Then it is filled with a syringe or the hand-held manometer until the blue buffer balloon inside fills the transparent envelope by two thirds to three quarters. This inflation diameter signals the optimal cuff pressure. This makes it easy for the nursing staff to visually check the pressure. A glance at the blue buffer balloon indicates whether everything is in order. This is also possible at a distance. This way, any necessary hygiene distance can be maintained without neglecting the control duties.

(1) L.Lorente, M. Lecuona, A. Jimenez, J. Cabrera, M. Mora: Subglottic secretion drainage and continuous control of cuff pressure used together save health carecosts. American Journal of Infection Control, 42 (10), 1101-5, 2014.
(2) L.Lorente, M. Lecuona, A. Jimenez et al: Continuous endotracheal tube cuffpressure control system protects against ventilator-associated pneumonia. Crit Care 2014; 18: R77.
(3) RKI source 78/79/80/81. See "Prevention of nosocomial ventilator-associated pneumonia" -.
Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO at the Robert Koch Institute).
(4) J. Edauvergne, A. Geffray, K. Asehnoune, B. Rozec, K. Lakhal: "Automatic regulation of the endotracheal tubecuff pressure with a portable elastomeric device. A randomised controlledstudy", 4 May 2020. https://doi.org/10.1016/j.accpm.2020.04.007

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