The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

EFFECT OF DEFLATED CUFFS, FENESTRATIONS, SPEAKING VALVES AND CAPPING ON EXHALATION WITH A TRACHEOSTOMY

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

BACKGROUND: Expiratory resistance is a factor that can complicate the process of weaning from a tracheostomy. There is limited literature concerning the effect of tracheostomy tubes (TT), speaking valves and capping on exhalation. There are a variety of TT to consider including: different brands/styles, different sizes, cuff versus cuffless, fenestrated versus non-fenestrated. We use many different TT sometimes in combination with speaking valves or capping, everyday in clinical care. We wanted to examine the effects of the TT and related devices on the exhalation phase. 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) Tracheostomy characteristics 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 TT were completely deflated during the study. We examined the expiratory “tracheal” pressure graphics with all of the various tracheostomy combinations which would indicate expiratory resistance. RESULTS: Our airway model showed 14 tracheostomy combinations that doubled the peak expiratory pressure and 5 tracheostomy combinations that more than tripled the peak expiratory pressure. Cuffed tubes with speaking valve or capped were the combinations with the highest peak expiratory pressures. Cuffless tubes created the least increase in peak expiratory pressures. See chart for data on all tracheostomy characteristics tested. CONCLUSIONS: Expiratory resistance is consistently increased by cuffed tubes during speaking valve and capping, as evidenced by the largest increases in peak expiratory pressures. Cuffless tubes consistently decrease the expiratory resistance. We are unsure of the effects that our observed increased expiratory pressure has on patients, however caution should be used whenever TT and related devices are used that could cause increased expiratory resistance. The expiratory pressures in our model were passive, a live patient could actively exhale creating greater expiratory pressures. Sponsored Research - None

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