A cuff pressure management device (10) for a tracheal breathing tube (54) with an inflatable cuff (90), comprises a volume displacement subsystem (36), a pressure transducer (44), a compliance determination circuit (34), and a cuff pressure controller (24). The volume displacement subsystem provides (i) a measured volume of pressurized gas to and from the cuff and (ii) a cuff gas volume signal. The pressure transducer provides a cuff gas pressure signal. The compliance determination circuit is configured to calculate cuff compliance and an estimated tracheal airway compliance based on the gas volume signal and the gas pressure signal. The cuff pressure controller is in controlling communication with the volume displacement subsystem and the compliance determination circuit to maintain cuff pressure based on the calculated cuff compliance.