Intermittent manual correction of the endotracheal tube cuff pressure (P_cuff) may delay the detection of underinflation (source of contaminated oropharyngeal content microaspiration) or overinflation (exposing to airway damage). Devices for automated continuous correction of P_cuff are appealing but some are inconvenient, expensive or even harmful. This prospective randomised controlled study tested whether the tracoe Smart Cuff Manager™ reduced the rate of patients undergoing≥1 episode of underinflation (P_cuff<20 cmH₂O), as compared with routine manual P_cuff correction. The rate of patients with≥1 overinflation episode (P_cuff>30 cmH₂O) and the incidence of under/overinflation were also compared.

Patients with acute brain injury and likely to receive invasive mechanical ventilation for>48h were randomly allocated to receive, during 48h, automated P_cuff correction (combined with manual correction) or manual correction alone. P_cuff was measured with a dedicated manual manometer, at least every 8h.

Sixty patients were included and randomised (32 patients with manual and 28 with automated P_cuff correction) for 506 measurements of P_cuff (269 and 237, respectively). Automated correction of P_cuff was associated with a lower rate of patients with≥1 episode of underinflation (63% and 18%, respectively, P<0.001), a lower incidence of underinflation episodes (15% vs. 2%; P<0.001), a lower rate of manual corrections (77% vs. 58%; P<0.001). For overinflation, there were no significant between-groups differences (2% vs. 2%). The incidence of early respiratory infections was similar in both groups (29% vs. 25%, P=0.78).

The adjunction of continuous P_cuff control with the Tracoe Smart Cuff Manager™ to routine manual intermittent correction reduced the incidence of P_cuff underinflation episodes without provoking overinflation.

ClinicalTrials NCT03330379. Registered 6 November 2017, NCT03330379.