The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

BENCH EVALUATION FOR EFFECTS OF FENESTRATIONS, SPEAKING VALVES AND CAPPING ON WORK OF BREATHING THROUGH TRACHEOSTOMY TUBES

John S. Emberger, Lisa Racine, Eric Krauss, Joel M. Brown; Respiratory Care, Christiana Care Health System, Newark, DE

BACKGROUND: Tracheostomy tubes (TT) and related devices may impose an increased work of breathing for spontaneously breathing patients. There is limited evidence for how different TT effect work of breathing, such as: tracheostomy brand/style, tracheostomy size, cuff versus cuffless, fenestrated versus nonfenestrated, use of speaking valve and TT capping. We use a variety of combinations of these TT daily in patient care. We wanted to determine how these TT and related devices such as speaking valves and capping effect inspiratory work of breathing. METHODS: We used a dual test lung (Michigan Instruments Inc.) with a lifting bar to simulate spontaneous breathing, connected to the trachea of our AirMan® manikin (Laerdal®). A NICO® Cardiopulmonary Management System (Philips Respironics) combined flowsensor was placed between the trachea and the dual test lung. A ventilator driving the dual test lung setup delivered simulated spontaneous breathing. (respiratory rate=20, tidal volume=400, I:E=1:2) TT tested were: size 4 and 6 Shiley®, cuffed (cuff ) and cuffless(cls), fenestrated (fen) or non-fenestrated. Speaking valve (Shiley®) and capping were also tested. The cuffs of the tracheostomy tubes were completely deflated during the study.We examined imposed inspiratory work of breathing of the various TT and related devices during spontaneous breathing. RESULTS: In our spontaneously breathing airway model, three combinations yielded high (> 0.6 J/L) work of breathing: size 4 cuffed with cap, size 6 cuffed with speaking valve and size 6 cuffed with cap. The combinations that were most similar to having no TT inplace were cuffless size 4 with and without fenestration as well as cuffless size 6 fenestrated. See the chart for work of breathing for all tracheostomy combinations tested. CONCLUSIONS: Cuffless 4 and cuffless 6 tracheostomy tubes were associated with the least imposed work of breathing. Caution should be used when capping a 4 or 6 cuffed tracheostomy tube and when using a speaking valve on a 6 cuffed tracheostomy tube. Sponsored Research - None

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