Tracheostomy Tube Cuff Inflated or Deflated?

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curiousgeorge
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Tracheostomy Tube Cuff Inflated or Deflated?

Postby curiousgeorge » Mon Dec 07, 2015 1:55 am

My relative was trached and cannot speak. The doctors tell me that the cuff must be inflated during the day and/or for sleep. What should I do?

(Asked by a family member)

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bachjr
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Re: Tracheostomy Tube Cuff Inflated or Deflated?

Postby bachjr » Mon Dec 07, 2015 1:56 am

Besides clinicians thinking that “ventilator dependent people” require tracheostomy tubes for TMV and ventilator alarms, they also think that the cuff on the tracheostomy tube needs to be inflated, especially during sleep. This has resulted in people using CTMV being unable to speak since speech is not possible with the cuff inflated. As we reported as early as in 1990, the cuff almost never needs to be inflated for effective CTMV when using proper ventilator settings. We demonstrated that when the brain and throat muscles function and the drive to breathe is not depressed by sedatives and oxygen cuffs are unnecessary.

Without cuffs, the air leakage around the tube and up and out of the nose and mouth can be compensated for by increasing the preset ventilator volumes, switching to pressure preset, and/or using cuffless tubes of greater diameter. There has been, at most, only one publication on this subject since 1990. In addition, it has become clear that patients whose breathing support can be adequate without cuffed tracheostomy tubes do not need the tubes in the first place but can be supported by NVS and should be evaluated to have their tubes removed (be decanulated).

Reference:
Bach JR, Alba AS. Tracheostomy ventilation: a study of efficacy with deflated cuffs and cuffless tubes. Chest 1990;97(3):679-683.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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