How to Test for Pressure Necrosis in an Endotracheal Tube

You don't want to cause any kind of pressure necrosis in a kid's trachea. We do know that about 35 millimeters of mercury is a place where you start to see an ischemia in the tracheal mucosa. So what I typically do is once the tube is placed put in a little bit of air just so that we can ventilate effectively initially and then listen over the neck with my syringe on the pilot balloon. Right and those doses at least for a short period of time are well tolerated. They are well tolerated and we haven't really been able to demonstrate tolerance.