A system (100) and method (308) for determining cuff rupture in a cuffed endotracheal tube device (102) introduced into the trachea of a subject, the system comprising: a pressure sensor configured for monitoring cuff pressure in the cuff (210) to produce cuff pressure data; a processing unit (116) configured for searching for a statistically significant frequency of pressure spikes in said monitored cuff pressure, and, when said statistically significant frequency is found, issue an alert that said cuff is ruptured or punctured.