The cuffs of the tracheal tubes which are currently recommended and routinely used in long-term (more than 2 days) ventilation are made of polyvinyl chloride and have a high volume cylindrical shape, allowing a low pressure after inflation, designed to cover the tracheal wall without inducing ischemic lesions of the tracheal mucosa. Such lesions are responsible for laryngeal edema - a clinical stridor after extubation occurs in around 12% of patients -, and rarely for granuloma and stenosis which induce sequelae which are disabling and/or difficult to repair with surgery. The use of tube coated with antiseptics is currently under investigation. Protection against tracheal lesions induced by the tracheal tube requires a regular and frequent assessment of the cuff pressure over the day and night time. Recent experimental studies showed that these cuffs are bad protectors against micro-inhalations around the cuff. Several companies provide us with new polyurethane cuff tubes, which physical characteristics are associated - in VITRO, on animal tracheas, and during general anesthesia to a better tightness than polyvinyl chloride cuffs. They also provide us with conic shaped cuffs, made out of either PVC or polyurethane. Authors found that the Hi-Lo and the SEALGUARD cuffs have similar capabilities to prevent against methylene blue leakage, and others did not find a preventive effect of the pressure control of the Hi-Lo cuff against VAP. A reduction of early VAP was observed in one series after cardiac surgery.