management of tracheostomy

  • anatomy and types of tracheostomies
  • passy muir
    • no cuff leak: don’t use. Might not be able to exhale
    • drop cuff to eat so that esophagus can expand
  • trach
    • if able to, leave cuff down forever

  • single lumen less irritation, easier air flow, may be easier to liberate
  • double lumen: removable, easier to clear secretions, can clean or replace afterwards
  • double lumen generally considered safer to use because can remove to clean.

  • cuffless trach: moving towards speaking. Reduced risk of trauma from balloon
  • cuffed trach: can be used more with mechanical ventilation. Can also reduce aspiration
  • goal pressure: 18-25. Deflate cuff when able.
  • speaking valve: able to tolerate deflation, minimal secretion, alert, medically stable, no upper airway obstruction
  • fenestrated tube will also allow air to flow upwards for phonation

  • fenestration can irritate airway. Not used very often.
  • swallowing: deflate cuff to avoid exertion of pressure on esophagus

To learn

  • tracheostomy downsizing