LAUSR

Paediatric cuffed endotracheal tubes were developed to effectively seal the airway around the tube while avoiding excessive transmucosal pressure, because the microthin polyurethane cuff membrane seals the airway at ultra-low pressure. However, the manufacturer’s website reported that the micro-thin polyurethane material used to make endotracheal tube cuffs could exhibit water condensation within the cuff, and condensation in the inflation line and pilot balloon could cause inaccurate reading of intracuff pressure. We experienced a case of cuff leakage by the combination of water condensation and a continuous automatic cuff pressure monitor. Consent of the patient’s next of kin was obtained for publication. A six-year-old boy with viral pneumonia caused by severe influenza A was admitted to the intensive care unit (ICU). He was 110 cm in height and weighed 20 kg. Immediately after admission to the ICU, his trachea was intubated with a 5.5 mm cuffed endotracheal tube (Microcuff VR Paediatric Endotracheal Tube, Halyard Health Inc, Yokohama, Japan). His lungs were mechanically ventilated (Puritan Bennett 840R ventilator, Covidien Japan, Tokyo, Japan). He was on pressure control ventilation set at a fraction of inspiratory oxygen of 60%, a driving pressure of 15 cmH2O, an inspiratory interval of 0.8 s, positive end-expiratory pressure of 10 cm and 20 mandatory breaths by mechanical ventilation. Intracuff pressure was set at 15 cmH2O and monitored by a continuous automatic cuff pressure monitor (Electronic cuff pressure controllerR , Covidien Japan, Tokyo, Japan). At two days after ICU admission, ventilatory failure occurred because of endotracheal tube cuff leakage. The child showed no signs of inadequate sedation or Water condensation Water condensation (a) (b) (c)