Relationship between difference in endotracheal tube cuff area and airway area with minimum cuff pressure for adequate airway sealing: a prospective observational study | Scientific Reports

Feb 19, 2025

Scientific Reports volume 15, Article number: 5875 (2025) Cite this article

Metrics details

It is essential for clinicians to select the appropriate endotracheal tube to ensure effective airway management. However, an unmatched endotracheal tube cuff area to the airway area can lead to air or secretion leakage, even at the recommended cuff pressure of 20–30 cmH2O. The present multicenter prospective observational study aimed to determine the relationship between the difference in cuff area and airway area with the minimum cuff pressure to avoid airway leakage. Adult patients who underwent mechanical ventilation were assigned into three groups, with a minimum cuff pressure of < 20, 20–30, and > 30 cmH2O, respectively, in order to have adequate airway sealing. The primary outcome was the difference between the endotracheal tube cuff area and airway area (cuff-airway area difference) that was calculated for the three groups. A total of 284 patients were included, with the mean age of 65.19 (± 14.03) years old. There were 166, 63 and 55 patients who required a minimum cuff pressure of < 20, 20–30 and > 30 cmH2O, respectively. The mean cuff-airway area difference was 236.00 ± 85.26, 149.70 ± 48.34 and − 12.29 ± 113.0 mm2 in the < 20, 20–30, and > 30 cmH2O groups, respectively. In addition, the simple linear regression analysis revealed a negative linear relationship between the cuff-airway area difference and minimum cuff pressure (Y = -0.1266 × X + 46.50, F = 571.40, p < 0.001). It can be concluded that a significant number of patients require a cuff pressure out of the recommended range (< 20 or > 30 mmH2O) to have adequate airway sealing. Patients with a lower cuff-airway area difference require a higher minimum cuff pressure to seal the airway.

Endotracheal intubation for invasive mechanical ventilation (MV) is a treatment method to deliver air into the patient’s lungs1,2. In general, a pressure of 20–30 cmH2O inside the endotracheal tube cuff is recommended to create sufficient sealing between the cuff and patient airway3,4,5. However, studies conducted by the investigators and other research groups have revealed that some patients require a cuff pressure of > 30 cmH2O to seal the airway during MV6,7,8, 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024)." href="#ref-CR9" id="ref-link-section-d142480480e612_3">9,10,11,12,13,14,15, while other patients require a cuff pressure of < 20 cmH2O to seal the airway7,16,17. In clinic, physicians commonly select an endotracheal tube based on its diameter, without knowing the size and pressure in the cuff18. In addition, different brands of endotracheal tubes can have different cuff sizes, even when these have the same tube diameter7. Furthermore, the size of the patient airway is correlated to multiple factors, such as age, gender, height, and body mass index (BMI)7, 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024)." href="/articles/s41598-025-85355-x#ref-CR9" id="ref-link-section-d142480480e643">9,18,19,20,21,22. All these factors can contribute to an unfitted endotracheal tube in the trachea, leading to leakage after intubation. The previous study conducted by the investigators revealed that gender, age, height, BMI, type of surgical operation, route of oral intubation, and the difference between the cuff inner diameter and tracheal area were the factors that contributed to airway leakage 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024)." href="/articles/s41598-025-85355-x#ref-CR9" id="ref-link-section-d142480480e653">9. Among these factors, the surgical operation, route of oral intubation, and the difference between the cuff inner diameter and tracheal area were the primary causes. Thus, the present study performed an additional study to further investigate the relationship between the endotracheal tube size and patient airway, in order to facilitate the selection of an appropriate endotracheal tube for intubation, and ensure patient safety.

The present study aimed to investigate the area difference between the endotracheal tube cuff and patient airway when the airway is sealed, in order to provide a new strategy to select the appropriate endotracheal tube in clinical practice.

The present multicenter prospective observational study was conducted in three intensive care units (ICUs) in two tertiary hospitals in Nantong, China, from March 2020 to July 2022. These three ICUs included two cardiothoracic ICUs and one respiratory ICU. The study protocol received the approval from the ethics committee at each hospital. Each study participant or healthcare proxy provided a signed informed consent.

The participant inclusion criteria were, as follows: (1) patients who received MV with nasal or oral endotracheal intubation; (2) patients who were ≥ 18 years old; (3) patients who had normal vital signs, with a urine output of ≥ 2 ml/kg/hr; (4) patients with chest computed tomography (CT) scan results in the previous three months. The participant exclusion criteria were, as follows: (1) patients with massive pleural effusion; (2) patients with pneumothorax; (3) patients with a peak airway pressure of ≥ 45 cmH2O during MV.

The following equipment and devices were used for the endotracheal intubation: reinforced endotracheal tube (Galanz Medical Equipment, China; Smith Medical Devices, China; Weili Medical Equipment, China), cuff pressure gauge (Ranran Trade, China), stethoscopes (Hausheng Technology and Trade, China), and retractable tube with a 1.5 m suction loop (Intesec Medical Devices, China).

The anesthesiologists were responsible for the oral and nasal endotracheal intubation of all study participants. In general, the tube size would range within 7.5–8.5 and 7.0–8.0 mm for male and female patients, respectively, during oral endotracheal intubation, and range within 7.0-7.5 and 6.5–7.0 mm for male and female patients, respectively, during nasal endotracheal intubation23,24. However, the anesthesiologists had the flexibility to select the endotracheal tube with the appropriate size, according to experience and clinical judgment. After the successful intubation, the anesthesiologists decided on the MV mode.

The patient demographics, height, weight, and surgical vs. non-surgical issues were recorded. Information on the inner diameter (ID, 3.0–9.0) of the endotracheal tube was documented. The cross-sectional cuff area of the tracheal tube was calculated, as follows: cross-sectional cuff area = π × r225, with r = L/2. The cuff diameter (L) was obtained from the manufacturer’s manual.

The correct position of the endotracheal tube was confirmed by bedside chest X-ray. The patient airway cross-sectional area was calculated in the transverse CT image at the slide that corresponded to the level of the endotracheal tube cuff in the airway in the hospital picture archiving and communication system. The difference between the endotracheal tube cuff area and airway area (cuff-airway area difference) was calculated, as follows: cuff-airway area difference = cross-sectional cuff area - cross-sectional airway area.

Within 24 h after endotracheal tube placement, the minimal occlusive volume technique was applied to determine the lowest endotracheal tube cuff pressure, and prevent air leakage, as previously described26. Briefly, the patient was placed in the 30-degree semi-recumbent position. After cleaning the patient airway and nasal cavity, the endotracheal tube cuff was slowly deflated. Once the air leakage was heard, as determined by the auscultation at the trachea using a stethoscope, the cuff was slowly re-inflated. When the air leakage sound disappeared, the value displayed on the balloon pressure gauge (VBM, Germany) was documented as the minimum cuff pressure to prevent air leakage. This measurement was separately performed twice by two anesthesiologists. The average of two measurements was used for the data analysis.

The present study was a prospective observational study designed to explore the relationship between the difference in cuff area and airway area with the minimum cuff pressure. Due to the exploratory nature of the study and lack of relevant previous data, a formal sample size calculation was not conducted. All eligible cases during the study period were collected to explore the research question.

All enrolled patients were assigned into two groups based on the minimum cuff pressure to prevent air leakage (≤ 30 cmH2O and > 30 cmH2O groups). The normal distribution and logarithmic econometric data were presented in mean ± standard deviation or median with interquartile range, and compared by t-test or Mann-Whitney test, depending on the normality test results. The categorical data were presented in numbers with percentages, and compared by Chi-square test. Simple linear regression analysis was used to evaluate the relationship between the cuff-airway area difference and minimum cuff pressure. All statistical analyses were performed using SPSS (version 25.0; IBM, USA). The figures were created using Prism 8 (GraphPad, USA). A p-value of < 0.05 was considered statistically significant.

A total of 457 patients, who underwent MV during the study period, were screened. Among these patients, 284 patients were included for the present study, which comprised of 209 (73.6%) male and 75 (26.4%) female patients. The mean age of these patients was 65.19 (± 14.03) years old. A total of 166, 63 and 55 patients had a minimum cuff pressure of < 20, 20–30, and > 30 cmH2O, respectively. The characteristics of these patients are listed in Table 1.

As shown in Fig. 1, there was a strong linear relationship between the independent variable “cuff inner area minus tracheal area” and dependent variable “minimum cuff pressure when the airway is closed”, with p < 0.001, indicating that the independent variable had a pronounced effect on the dependent variable.

Comparison of cuff-airway area differences (differences in endotracheal tube cuff area and airway area) under different cuff pressures.

The mean cuff-airway area difference was 236.00 ± 85.26, 149.70 ± 48.34, and − 12.29 ± 113.0 mm2 in the < 20, 20–30 and > 30 cmH2O groups, respectively. This indicates that patients with a lower cuff-airway area difference required a higher minimum cuff pressure to seal the airway (Fig. 2).

Comparison of the difference between the area of the cuff and area of the airway, when the airway was closed, at different stages of the minimum pressure of the cuff.

The present study investigated the relationship between the cross-sectional area of the cuff and cross-sectional area of the patient’s airway. It was found that a significant number of patients required < 20 or > 30 mmH2O cuff pressure to have adequate airway sealing. In addition, there was a negative linear relationship between the cuff-airway area difference and minimum cuff pressure. That is, a small cuff area could have airway leakage even at a cuff pressure > 30 cmH2O, while a large cuff area could cause the cuff wall to wrinkle, and allow airway secretions to flow into the airway. Therefore, clinicians should consider the cuff-airway area difference when selecting the appropriate endotracheal tube.

The recommended cuff pressure during tracheal intubation is 20–30 cmH2O, but air leakage during endotracheal intubation has been frequently reported in clinic27. The present study revealed that a significant number of patients (55 patients, 19.37%) required a cuff pressure of > 30 cmH2O to achieve adequate sealing. Therefore, it is important to identify a way to help clinicians select the appropriate endotracheal tube and cuff pressure, in order to provide adequate airway sealing during MV. Furthermore, the present study provided clinical evidence that patients with a low cuff-airway area difference were more likely to require a higher minimum cuff pressure for adequate sealing in the airway. This finding can help clinicians select the appropriate endotracheal tube, and decide on the cuff pressure during MV.

In the present study, it was found that there is a negative linear relationship between the cuff-airway area difference and minimum cuff pressure. That is, as the cuff-airway area difference decreased, the minimum cuff pressure required to seal the airway increased. This suggests that a smaller difference between the cuff and airway area would carry a higher risk to have airway leakage, and require a higher cuff pressure to have adequate airway sealing.

As shown in Fig. 3A, the cuff of the endotracheal intubation was too small during MV. A tracheal tube with a small-sized cuff area would be more prone to have airway leakage in clinical practice8, 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024)." href="/articles/s41598-025-85355-x#ref-CR9" id="ref-link-section-d142480480e1510">9,28. Several guidelines have recommended to maintain a cuff pressure of 20–30 cmH2O29,30,31. Therefore, clinical nurses focus more attention to the guidelines that require them to manage a cuff pressure of 20–30 cmH2O during tracheal intubation, while overlooking the role of the cuff, in effectively sealing the patient’s airway6,8, 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024)." href="/articles/s41598-025-85355-x#ref-CR9" id="ref-link-section-d142480480e1535">9,32. The cuff in the endotracheal tube maintains adequate sealing in the airway, and prevents leakage33,34. When the cuff area is smaller than the patient’s airway area, the cuff cannot seal the airway even when the cuff pressure reaches 30 cmH2O. If the pressure inside the cuff is greater than 30 cmH2O, the pressure inside the cuff may not be equal to the pressure on the lining of the airway mucosa. Oral and nasal secretions can leak into the airways, and cause complications, such as ventilator-associated pneumonia. This situation might be more frequently encountered during nasotracheal intubation. Due to the small diameter of the patient’s nasal cavity, and in order to improve the success rate of the nasotracheal intubation, some anesthesiologists might choose an endotracheal tube with a narrow diameter, which could result in a small difference between the cuff area and airway area (a small cuff-airway area difference). As shown in the present study, a small cuff-airway area difference commonly required a higher minimum cuff pressure to completely seal the airway.

Illustrations of the relationship between the endotracheal tube cuff area and airway area. (A) The cuff area was smaller than the airway area; (B) The cuff area was similar to the airway area; (C) The cuff area was larger than the airway area.

As shown in Fig. 3B, when the tracheal intubation cuff pressure was between 20 and 30 cmH2O, the cuff could seal the patient’s airway. The average cuff-airway area difference was 149.70 ± 48.34 mm2.

As shown in Fig. 3C, the cuff of the tracheal intubation tube was too large during MV. A large-sized cuff can lead to tube folding in the airway35. For the 284 patients surveyed for MV, it is noteworthy that the proportion of patients with an excessive cuff area was relatively large (58.5%, 166/284). As a result, the cuff of most patients that underwent tracheal intubation may wrinkle, and airway secretions may flow into the airways.

A previous study reported a significant difference in the cuff area provided by different manufacturers, even when the endotracheal tube was labeled as the same size36. Therefore, the investigators suggest that clinicians should pay attention to this during endotracheal intubation.

The strengths of the present study include its multi-center design, and the relatively large sample size. The present study had several limitations. First, the study was performed for Chinese patients. Thus, the results might not be generalized to patients in other countries. Second, most of the patients were male patients with oral endotracheal intubation, which might introduce selection bias into the present study. Third, although all eligible cases were collected during the study period, a robust statistical calculation was not performed, which might have resulted in small sample bias, and inadequate power to reveal the difference. Finally, the patients were not followed up to determine the clinical outcomes. Future studies would address these issues.

Even when the recommended cuff pressure is 20–30 cmH2O, a number of patients require a pressure of > 30 mmH2O or < 20 mmH2O to have adequate airway sealing. The negative association between the cuff-airway area difference and minimum cuff pressure for adequate sealing suggests that patients with a lower cuff-airway area difference require a higher minimum cuff pressure to seal the airway. Clinicians should consider the cuff-airway area difference when selecting the appropriate endotracheal tube for MV.

The supporting data for the study findings are available from the corresponding author upon request.

Chen, H., Chen, Z. Z., Gong, S. R. & Yu, R. G. Visualizing the dynamic mechanical power and time burden of mechanical ventilation patients: an analysis of the MIMIC-IV database. J. Intensive Care. 11, 58 (2023).

Article PubMed PubMed Central MATH Google Scholar

Park, S., Kwon, Y. I. & Kim, H. J. Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study. Front. Med. (Lausanne). 10, 1161566 (2023).

Article PubMed Google Scholar

Saxena, D., Raghuwanshi, J., Dixit, A. & Chaturvedi, S. Endotracheal tube cuff pressure during laparoscopic bariatric surgery: highs and lows. Anesth. Pain Med. (Seoul). 17, 98–103 (2022).

Article PubMed Google Scholar

Ferreira, T. H., Allen, M., De Gasperi, D., Buhr, K. A. & Morello, S. L. Impact of endotracheal tube size and cuff pressure on tracheal and laryngeal mucosa of adult horses. Vet. Anaesth. Analg. 48, 891–899 (2021).

Article PubMed Google Scholar

Wang, W. Z. et al. A mobile terminal application program was used for endotracheal tube cuff pressure measurement. J. Clin. Monit. Comput. 35, 463–468 (2021).

Article CAS PubMed MATH Google Scholar

Wu, H. L., Zhang, Y. M., Shi, J. H., Ji, P. P. & Shen, W. Q. Endotracheal cuff undersizing diagnosed by computed tomography: Case report. Clin. Case Rep. 9, e05193 (2021).

Article PubMed PubMed Central Google Scholar

Wu, H. L., Shi, H. Y., Shi, J. H. & Shen, W. Q. Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH(2)O during mechanical ventilation: a cross-sectional study. Pak J. Med. Sci. 39, 460–466 (2023).

Article PubMed PubMed Central MATH Google Scholar

Zhang, Y. N. et al. Effect of varying cuff sizes with identical inner diameter on endotracheal intubation in critically ill adults: a sealed tracheal controlled trial. Med. (Baltim). 103, e38326 (2024).

Article CAS Google Scholar

Wu, H. L. et al. Risk factor evaluation of cuff pressure of > 30 cmH(2)O to stop air leakage during mechanical ventilation: a prospective observational study. Nurs. Open. 11, e2187 (2024).

Article PubMed PubMed Central MATH Google Scholar

Rosero, E. B., Ozayar, E., Eslava-Schmalbach, J., Minhajuddin, A. & Joshi, G. P. Effects of increasing Airway pressures on the pressure of the endotracheal tube Cuff during Pelvic laparoscopic surgery. Anesth. Analg. 127, 120–125 (2018).

Article PubMed Google Scholar

Peters, J. H. & Hoogerwerf, N. Prehospital endotracheal intubation; need for routine cuff pressure measurement? Emerg. Med. J. 30, 851–853 (2013).

Article PubMed MATH Google Scholar

Nseir, S. et al. Variations in endotracheal cuff pressure in intubated critically ill patients: prevalence and risk factors. Eur. J. Anaesthesiol. 26, 229–234 (2009).

Article PubMed Google Scholar

Selman, Y., Arciniegas, R., Sabra, J. M., Ferreira, T. D. & Arnold, D. J. Accuracy of the minimal leak test for endotracheal cuff pressure monitoring. Laryngoscope 130, 1646–1650 (2020).

Article PubMed Google Scholar

Sanaie, S. et al. Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques. J. Cardiovasc. Thorac. Res. 11, 48–52 (2019).

Article PubMed PubMed Central Google Scholar

Galinski, M. et al. Intracuff pressures of endotracheal tubes in the management of airway emergencies: the need for pressure monitoring. Ann. Emerg. Med. 47, 545–547 (2006).

Article PubMed Google Scholar

Dave, M. H., Frotzler, A., Spielmann, N., Madjdpour, C. & Weiss, M. Effect of tracheal tube cuff shape on fluid leakage across the cuff: an in vitro study. Br. J. Anaesth. 105, 538–543 (2010).

Article CAS PubMed Google Scholar

Yue, S., Mengmeng, B. & Z, C. Summary of best evidence for Artificial Airway Airbag Management in ICU Patients[J]. Chin. J. Nurs. 57, 3038–3045 (2022).

MATH Google Scholar

Ritchie-McLean, S., Ferrier, V., Clevenger, B. & Thomas, M. Using middle finger length to determine the internal diameter of uncuffed tracheal tubes in paediatrics. Anaesthesia 73, 1207–1213 (2018).

Article CAS PubMed Google Scholar

Turbpaiboon, C. et al. Characteristics of lower airway parameters in an adult Asian population related to endotracheal tube design: a cadaveric study. Sci. Rep. 14, 6137 (2024).

Article ADS CAS PubMed PubMed Central MATH Google Scholar

Aljathlany, Y. et al. Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging. Ear Nose Throat J. 100, 629s–635s (2021).

Article PubMed Google Scholar

Ajmera, P. & Prasad, N. Comparison of Tracheal Diameter measurements on Radiograph Versus Computed Tomography at a Tertiary Care Hospital in Pune, Central India. Cureus 13, e13755 (2021).

PubMed PubMed Central Google Scholar

Chan, W. H. et al. Measurement of subglottic diameter and distance to pre-epiglottic space among Chinese adults. PLoS One. 15, e0236364 (2020).

Article CAS PubMed PubMed Central Google Scholar

E, A. W. S. Endotracheal Intubation in Anesthesia and rescue[M] (People’s Military Medical Publishing, 2005).

S, X. F. Difficult Endotracheal Intubation technique[M] (Science and Technology Literature, 2002).

Weijing, H. & Xiwen, M. & S, W. Teaching Design based on cognitive load theory and GeoGebra: taking the teaching of area of a Circle as an Example[J]. China Educ. Technol. Equip. 1–3 (2023).

Park, H. Y., Kim, M. & In, J. Does the minimal occlusive volume technique provide adequate endotracheal tube cuff pressure to prevent air leakage? A prospective, randomized, crossover clinical study. Anesth. Pain Med. (Seoul). 15, 365–370 (2020).

Article PubMed MATH Google Scholar

Satya Prakash, M. V. S., Aravind, C. & Mohan, V. K. Comparative evaluation of three methods of endotracheal tube cuff inflation for adequacy of seal. J. Anaesthesiol. Clin. Pharmacol. 38, 588–593 (2022).

Article CAS PubMed PubMed Central Google Scholar

Ban, M. G. et al. Accuracy of pilot balloon palpation for cuff pressure assessment in small versus large sized tubes: a prospective non-randomized observational study. Sci. Rep. 13, 5580 (2023).

Article ADS CAS PubMed PubMed Central MATH Google Scholar

Nseir, S. & Gaudet, A. Continuous Control of Tracheal Cuff Pressure and Ventilator-Associated Pneumonia: Beyond Agate and Feng Shui. Chest 160, 393–395 (2021).

Article PubMed Google Scholar

Totonchi, Z., Jalili, F., Hashemian, S. M. & Jabardarjani, H. R. Tracheal stenosis and Cuff pressure: comparison of minimal occlusive volume and palpation techniques. Tanaffos 14, 252–256 (2015).

PubMed PubMed Central Google Scholar

Bowton, D. L. Cuff pressure control: are the claims inflated? Crit. Care Med. 50, 1535–1537 (2022).

Article PubMed MATH Google Scholar

Vorobeichik, L., Yoo, S. J. & Cybulski, K. A. Inadvertent endotracheal Cuff Hyperinflation diagnosed by magnetic resonance imaging. Anesthesiology 128, 141 (2018).

Article PubMed Google Scholar

Bulamba, F. et al. Achieving the recommended endotracheal tube Cuff pressure: a Randomized Control Study comparing loss of Resistance Syringe to Pilot Balloon Palpation. Anesthesiol Res. Pract. 2032748 2017 (2017).

Rello, J. et al. Pneumonia in intubated patients: role of respiratory airway care. Am. J. Respir Crit. Care Med. 154, 111–115 (1996).

Article CAS PubMed Google Scholar

Jinqiu, Z., Yu, L. & P, F. Research progress on the influencing factors and monitoring methods of artificial airway airbag pressure[J]. Chin. J. Mod. Nurs. 26, 4161–4165 (2020).

MATH Google Scholar

Fischer, M., Grass, B., Kemper, M., Weiss, M. & Dave, M. H. Cuffed pediatric endotracheal tubes-outer cuff diameters compared to age-related airway dimensions. Paediatr. Anaesth. 30, 424–434 (2020).

Article PubMed Google Scholar

Download references

We would like to thank our colleagues at the Cardiothoracic Intensive Care Unit and Respiratory Medical Care Unit of the Affiliated Hospital of Nantong University, and the Cardiothoracic Intensive Care Unit of Nantong Third People’s Hospital for their significant contributions.

The study was funded by the 2021 Jiangsu Province Postgraduate Research & Practice Innovation Program in China (Grant number: SJCX21_1479), the 2021 Nantong Health Commission Research Initiative (Grant number: 2021006), and grants from Jiangsu Provincial Research Hospital (Grant number: YJXYY202204-YSB19).

Hong-lei Wu and Yue-hong Wu contributed equally to this work.

Nursing Department, Affiliated Hospital of Nantong University, Jiangsu, 226001, China

Hong-lei Wu, Yang-hui Xu & Hong-wu Shen

College of Nursing, Anhui University of Chinese Medicine, Hefei, 230012, Anhui, China

Yue-hong Wu

Nursing Department, Nantong University, Jiangsu, 226001, China

Wang-qin Shen

Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong University, Jiangsu, 226001, China

Jia-hai Shi

Intensive Care Unit of Nantong Third People’s Hospital, Affiliated Nantong Hospital Three of Nantong University, Jiangsu, 226001, China

Lei Ding

Intensive Care Unit of Southeast University Affiliated Zhong da Hospital, Jiangsu, 10000, China

Yan-ping Zhu

Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China

Mei-juan Lan

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

You can also search for this author in PubMed Google Scholar

HLW, MJL and YHW: patient recruitment, data collection, and manuscript draft; JHS: data analysis and study design; YHX and LD: patient recruitment, data collection, and informed consent process; HWS, JHS, YPZ and WQS: study design, patient recruitment, and manuscript proofreading.

Correspondence to Mei-juan Lan.

The authors declare no competing interests.

The study was approved by the ethics committee of The Affiliated Hospital of Nantong University, and Nantong Third People’s Hospital (No. 2021-K062-01). A written informed consent was obtained from all individual participants or their healthcare proxy. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

Wu, Hl., Wu, Yh., Shen, Wq. et al. Relationship between difference in endotracheal tube cuff area and airway area with minimum cuff pressure for adequate airway sealing: a prospective observational study. Sci Rep 15, 5875 (2025). https://doi.org/10.1038/s41598-025-85355-x

Download citation

Received: 26 July 2024

Accepted: 02 January 2025

Published: 18 February 2025

DOI: https://doi.org/10.1038/s41598-025-85355-x

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative