Cuffed tracheal tubes are used to prevent loss of tidal volume during positive pressure ventilation, minimise pulmonary aspiration of gastric and oral secretions, facilitate respiratory monitoring and, in the paediatric population, reduce the need for repeated laryngoscopy due to incorrect tube size. [1][2][3] These goals are achieved by appropriate cuff inflation. Cuff pressure (CP) should be >25 cmH 2 O to prevent aspiration and <30 cmH 2 O to avoid damage to surrounding structures. [4,5] Obstruction to blood flow occurs when CP exceeds capillary perfusion pressure, resulting in ischaemia of the tracheal mucosa. Blood flow is impeded at CP ≥30 cmH 2 O in normotensive adult patients, with total obstruction of flow occurring at CP ≥50 cmH 2 O. [5] No paediatric studies have been performed to assess capillary perfusion pressure or the CP at which tracheal capillary blood flow is impeded. The extent of damage from increased CP is related to the absolute pressure exerted by the cuff and the duration of this pressure (mucosal damage is noted to occur within 15 minutes of exposure to high pressures), with a greater contribution being from the absolute pressure. [5,6] Injuries from high CP range from mucosal ulceration to tracheo-oesophageal fistula. [6,7] Low CPs are also associated with risks, including the development of ventilator-associated pneumonia secondary to aspiration and compromised ventilation resulting from loss of positive pressure. [1,8] Internationally accepted consensus guidelines for optimal CP range and frequency of measurement are lacking. [9] A local nursing guideline suggests a CP range of 25 -30 cmH 2 O. [10] The 2015 American Heart Association Pediatric Advanced Life Support guidelines recommend using the manufacturer's specification for appropriate CP in children <9 years and suggest a reference range of 20 -25 cmH 2 O. [11] CP should be measured using a manometer or pressure transducer, as techniques such as digital palpation and the minimal leak technique Background. Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications. Objectives. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventional component. In the final stage nurses completed a self-administered questionnaire. Results. A total of 304 charts from 61 patients were reviewed. Patients' ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of ...

High-flow humidified oxygen (HFHO) is a respiratory therapy which allows the administration of an oxygen/air admixture via a nasal cannula at flows greater than 2 L/min. [1] The precise amount of oxygen delivered can be independently titrated to the oxygen flow with delivery of up to 100% oxygen attainable. In addition, the oxygen/air admixture is heated to a temperature of 34 °C and humidified to 'optimal humidity' with a water content of 44 mg/L. The benefits of HFHO therapy on the respiratory system appear to be numerous. [2,3] The high inspiratory flows result in reduced work of breathing, as well as washout of nasopharyngeal dead space. By warming and humidifying inspired gas, it firstly reduces the metabolic work of the patient, and secondly, it minimises the pulmonary broncho-constrictor response which is mediated by nasal muscarinic receptors. [4] In this way, both conductance as well as compliance in the lungs is improved. [5] Additionally, flows above 2 L/kg/min appear to provide some positive end-expiratory pressure (PEEP), estimated to be ~4 cmH 2 O. The amount of PEEP generated appears to be related to both the flow rate and size of the nasal cannula used. [6,7] At the time of embarking on our study, the use of HFHO therapy in infants with a diagnosis of bronchiolitis appeared to be a promising therapy, but its place in the routine management of these infants was not clear in the absence of data from high-quality RCT's. One RCT in infants with moderate bronchiolitis had shown that among infants given HFHO at 1 L/kg/min compared with those given 2 L nasal cannula oxygen, there was no difference between groups in terms of the time spent requiring oxygen. [8] This research aimed to test the hypothesis that there would be no difference in respiratory distress (as measured by the Modified TAL (M-TAL) score) in infants with bronchiolitis who have more severe disease (M-TAL score >6 and hypoxaemia in room air), when comparing standard oxygen therapy to HFHO therapy. The primary outcome assessed was the severity of respiratory distress (measured by the M-TAL score), and the secondary outcome