Purpose of review: Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (P_cuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of P_cuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP.

Recent findings: Current discontinuous monitoring and adjustment of P_cuff, even well performed, is inaccurate in maintaining P_cuff in the target range. Underinflation (P_cuff <20 cmH₂O) of tracheal cuff is an independent risk factor for VAP through microaspiration of contaminated subglottic secretions into the lower respiratory tract. Two main types of devices, electronic and pneumatic, have been developed for the continuous control of P_cuff. Both have shown effectiveness in maintaining P_cuff in recommended range in ICU patients, but only the pneumatic device has provided a reduction in microaspiration and VAP incidence.

Summary: Continuous controllers of P_cuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of P_cuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.

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