Quantitative Analysis of Endotracheal Tube Cuff Pressure-Volume Dynamics: Comparing Commercial Airway Simulators with Cadaveric Models

Introduction: The safety of airway management critically depends on provider training, yet the fidelity of simulation equipment remains unevaluated. This quality improvement study quantifies disparities between commercial airway simulators and cadaveric models to enhance standardization of simulation-based training and improve patient safety outcomes.

Methods: We conducted a systematic evaluation of endotracheal tube cuff pressure-volume relationships across three standardized models: Ambu Airway (rigid), Trucorp AirSim AdvancedX (flexible), and cadaveric airways. Using calibrated manometry, we measured cuff pressures with incremental air volumes in TaperGuard and Sheridan ETTs (sizes 6.0-8.0mm). We analyzed pressure-volume relationships within safe clinical parameters (20-30 cmH₂O) to assess training environment fidelity.

Results: Commercial simulators demonstrated significant deviations from cadaveric standards in pressure-volume dynamics. The rigid model showed excessive responsiveness (35-50 cmH₂O/mL), requiring minimal inflation volumes (0.18-0.29mL) that poorly replicate clinical conditions. The flexible model, while improved, still exhibited non-physiologic behavior (25-35 cmH₂O/mL). Cadaveric airways revealed critical characteristics absent in simulators: three-phase pressure response, gentler slopes (18-25 cmH₂O/mL), and consistent volume requirements (0.15-0.22mL). These disparities identify significant gaps in current simulation-based training.

Conclusions: This quality improvement analysis reveals important limitations in current airway simulation technology that may impact provider training and patient safety. The significant differences between simulator and cadaveric models highlight the need for enhanced simulation standards and improved training protocols. Implementation of these findings could standardize airway management education and potentially reduce adverse events related to endotracheal tube cuff pressure management.