A 132-kg, 168-cm female who underwent a tracheotomy 2 weeks ago remains in the ICU receiving VC ventilation. After the patient is repositioned, the ventilator high-pressure alarm sounds with each breath. What should a respiratory therapist do first?

Evaluating cuff pressure is essential in this scenario because high-pressure alarms on a ventilator often indicate that there is resistance to airflow, which can be caused by various factors including a problem with the artificial airway. In the case of patients with a tracheostomy, one common reason for the high-pressure alarm after repositioning is related to the cuff of the tracheostomy tube.

If the cuff pressure is too high, it can result in increased resistance to the ventilator's delivered tidal volume, leading to the high-pressure alarm sounding. Checking the cuff pressure allows the therapist to determine if it is within the recommended range (typically between 20-30 cm H2O). If the cuff pressure is too excessive, it may need to be adjusted to relieve pressure on the trachea and prevent complications, such as tracheal necrosis or erosion, while ensuring that adequate ventilation is maintained.

In summary, evaluating the cuff pressure is a critical first step as it directly addresses a potential and common issue that could be influencing the ventilator alarms, guiding the therapist towards necessary adjustments to ensure effective ventilation and patient safety.