Proper management of endotracheal cuff pressure is pivotal, not only to prevent complications like tracheal mucosal damage and micro aspirations but for efficient positive pressure ventilation. A prospective descriptive study was performed to examine the prevailing practices of endotracheal cuff pressure management (CPM) in adult intensive care units (ICUs) of the National Hospital of Sri Lanka. The auditors visited the ICUs without a prior warning and the CPM was assessed and the endotracheal cuff pressure (CP) was measured using an analogue manometer. Seventy four percent out of total of 50 patients examined had suboptimal cuff pressure recordings and 30% of them had alarmingly high pressures. Overall practice including documentation (14%), frequency (14%) and the method of CPM (20%) was significantly unsatisfactory warranting prompt measures to uplift the standards and prevent adverse consequences.