Correct and accurate inflation of the cuff is a crucial element in minimizing the complications of prolonged intubation, yet several tests show that medical staff finds it hard to inflate, maintain and estimate cuff pressure palpation. 
The accurate management of cuff pressure is specifically crucial in Pediatrics, yet studies show that a significant percentage of pediatric patients have a cuff pressure greater than the generally recommended upper limit. 
 Ramesh, Archana S. et al. An in vitro and in vivo validation of a novel monitor for intracuff pressure in cuffed endotracheal tubes.
 Lizy, Christelle et al. Cuff Pressure of Endotracheal Tubes After Changes in Body Position in Critically Ill Patients Treated With Mechanical Ventilation;
 Bhatti, Nasir I. et al. Cost analysis of intubation-related tracheal injury using a national database.
 Freebairn, Ross C. et al. Endotracheal Cuff Pressures in Ventilated Patients in Intensive Care.
 Kyaw, Moe H. et al. Healthcare utilization and costs associated with S. aureus and P. aeruginosa pneumonia in the intensive care unit: a retrospective observational cohort study in a US claims database (2015).
 Hoffman, Robert J. et al. Experienced Emergency Medicine Physicians Cannot Safely Inflate or Estimate Endotracheal Tube Cuff Pressure Using Standard Techniques.
 Bryant, Jason et al. Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon?
 Tobias, Joseph D. et al. Cuffed endotracheal tubes in infants and children: Should we routinely measure the cuff pressure?
 Schloss, Bryan et al. The laryngeal mask in infants and children: What is the cuff pressure?
The Clinical Need 
Mechanical ventilation and intubation of patients for longer than 48 hours puts the patient at risk of complications. Over-inflation of the cuff may result in injury of the trachea or the vocal cords, while under-inflation may result in aspiration of contaminated subglottic secretions into the lungs, which may cause Ventilator-Associated Pneumonia (VAP).
Those complications render the respiration procedure complex and costly, and may result in prolonged hospitalization and high mortality rates.    
The Risk of Aspiration
The Risk of Tracheal Tissue Injury