To Leak Or Not To Leak? To Occlude Or Not To Occlude? That Is Not The Only Question

The many questions being raised today about which cuff to use on tracheal tubes, what volumes to inject in the cuff, and what pressures in a cuff exert what pressures on the tracheal wall deserve notice and answers. Should we use large floppy cuffs that may take large volumes and relatively low internal pressures to occlude the trachea, or should we use small cuffs that usually take small volumes and high internal pressures to prevent a leak? Or, should we get a tight seal and then remove a small volume of air from the cuff to get a "minimal leak?"