A 49-kg female patient intubated on VC-CMV has persistent low-pressure and low-volume alarms with audible inspiratory murmuring. The most likely cause is?

• A. Ett cuff leak
• B. Bronchospasm
• C. Secretions
• D. Pneumonia

Answer: (A)

The situation points to a leak around the endotracheal tube cuff. When a patient is on volume-controlled ventilation, the ventilator delivers a fixed tidal volume. If the cuff isn’t sealing the trachea, gas leaks around the tube during inspiration, so less air reaches the lungs. That causes a lower delivered tidal volume and a lower circuit pressure, triggering persistent low-volume and low-pressure alarms. The audible inspiratory murmuring is the sound of air escaping around the cuff into the upper airway.

Bronchospasm would typically raise airway resistance and peak pressures rather than cause a leak sound. Secretions or pneumonia affect airway clearance and gas exchange over time and don’t usually produce the characteristic audible leak with simultaneous low alarms. In this scenario, checking and securing the cuff (and possibly replacing the tube if needed) is the appropriate next step.