Small residual-volume, small-contact area, high-pressure cuffs and disk “cuffs” are to be condemned. Large-volume, large-contact area, low-pressure cuffs are recommended as intracuff pressures equal tracheal mucosa pressures and airway pressures during positive pressure inflation. Tracheal mucosa pressure can be kept at 15 torr during exhalation to prevent aspiration without mucosal ischemia. The sponge cuff may fail to provide no-leak ventilation and protection against aspiration when used open. However, if a large enough sponge cuff is chosen and the pilot tube is clamped, it performs as a safe, low-pressure cuff. The McGinnis balloon effectively limits tracheal mucosa pressure to 25 torr despite accidental overinflation. With proper use of currently available large cuffs, serious cuff-induced tracheal wall damage should be totally preventable.