Question
What do we have to know about the patient’s tracheostomy tube?
Answer
The width, length, type, and shape of a tracheostomy tube may mean the difference between a tube that easily allows airflow through and around it and one that is impenetrable from any attempts at upper airflow (Epstein, 2005). When we deflate the cuff while a patient is on the ventilator, the most important thing we are evaluating is whether or not the patient can breathe over the tube and out through the nose and mouth. We don’t want the tube to be too small or the patient may have difficulty obtaining access to adequate volumes from the ventilator, but when off the ventilator, smaller is typically better. Ideally, when the patient is “liberated” from the ventilator and they no longer need it to breathe, the patient should be considered for a tracheostomy tube “downsize” and/or to a “cuffless” tracheostomy tube. A downsize simply means a smaller tube (e.g., a #8 to a #6) and a cuffless tube no longer has the cuff used to block air to the upper airway to increase the efficiency of ventilation to the lungs. A cuffless tracheostomy tube is sometimes all you need to achieve adequate upper airflow because the cuff, even when deflated, takes up a substantial amount of space in the trachea. Other times you may need a downsize. Other times you may need a fenestrated tube (with windows) to allow even more airflow through the tracheal space. All of these options have costs and benefits that will need to be considered with IDT.
This Ask the Expert is an excerpt from the course 20Q: Beyond the Swallow - Tracheostomy Tube and Ventilator Management presented by George Barnes, MS, CCC-SLP.
