A 58-year-old male with severe aortic stenosis is scheduled for open abdominal surgery. The anaesthetist selects a high-volume, low-pressure (HVLP) endotracheal tube cuff. The PRIMARY advantage of an HVLP cuff over a low-volume, high-pressure cuff in prolonged surgery is that it:

• A Requires less cuff pressure to achieve an effective seal against aspiration
• B Provides a tighter seal in patients with high peak airway pressures on mechanical ventilation
• C Prevents nitrous oxide-induced cuff pressure increases during anaesthesia
• D Distributes pressure over a larger mucosal area, reducing risk of mucosal ischaemia and tracheal necrosis ✓

Explanation

HVLP cuffs have a large diameter and low resting volume when deflated, but when inflated they make broad contact with the trachea, distributing pressure over a larger mucosal surface area. This reduces the pressure gradient at any single point, lowering the risk of mucosal ischaemia, tracheal stenosis, and cricoid rupture during prolonged intubation. The cuff still requires adequate pressure (20 to 30 cm H2O) to seal, but the design itself protects against focal high-pressure injury.

Reference: Miller's Anesthesia, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.