An air leak should not occur around a properly inflated endotracheal tube cuff. The presence of an air leak may be an indication of a traumatic tracheal injury.
Causes of an air leak around an endotracheal tube:
(1) underinflated cuff (resulting in a poor seal)
(2) balloon rupture or air leak
(3) defective valve to the cuff
(4) cuff placement above the vocal cords
(5) tracheal tear or other injury
It is important to inspect the tube prior to insertion and not to use one that has been damaged. The amount of air required to inflate the cuff in order to obtain a good seal should be known.
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