QUESTION: I am on a vent users’ listserv, and …

1 4 VENTILATOR- assisted living June 2011 Vol. 25, No. :I am on a vent users listserv, and periodically the group discussescuffed vs. uncuffed trach tubes. Can someone explain when and why a cuffedtrach tube is preferable? When is it not? If a cuffed trach tube is used, whenshould it be inflated?ANSWER:Linda Dean, RRT,Clinical Specialist, Passy-Muir, are numerous types and brands of tracheostomy tubes and three primary types ofcuffs. Each cuff is filled with a different medium air, water or foam. Regardless of what itis filled with, the cuff has one purpose, and that is to sealthe airway to control mechanical ventilation.

2 During theacute disease process, when a patient is in critical care, itmay be necessary to keep the cuff inflated so that all ofthe air delivered from the ventilator goes to the lungs andthen back to the ventilator on exhalation to be measuredand monitored. As the patient becomes more stable, adeflated cuff or cuffless tubemay be introduced. Patients who require full-timeventilation may prefer the cuffdeflated to enable speech,either through leak speech orthe use of a Passy-Muir Speaking Valve. At nighttime, there aresome patients who still need the cuff inflated because they fall sodeeply asleep and the throat muscles relax so much that largeamounts of air leak out of the mouth and is a common misconception that the inflated cuff of a tracheostomy tube will protect theairway and prevent aspiration.

3 This is simply not so. The definition of aspiration is any mate-rial that falls below the level of the vocal cords. The material that has reached an inflatedcuff is already aspirated. A cuff can actually make it more difficult to swallow and increasethe risk of aspiration. Some research has shown that a tracheostomy withan inflated cuff impairs laryngeal movement duringthe swallow, decreases sensation in the oral pharynx,decreases the normal pressures in the airway duringswallow and renders the natural cough (protectivemechanism) ineffective. Therefore, if a patient doesnot need the cuff for ventilation, the tracheostomytube cuff should be deflated or the patient should beevaluated for a cuffless tube.

4 Cuff deflatedAirflow with cuff deflated and Passy-Muir ValveCuff living June 2011 Vol. 25, No. 3 5On rare occasions, for the patient with a very severe swallow impairmentand no ability to protect the airway ( a patient at the end stage ofALS), an inflated cuff is the only way to minimize aspirated material fromentering the lower summary, there are many tubes and cuff options for the tracheostomypatient. It is best to consult with the health care team to determine whichoption best meets an individual s ventilation, communication and swallow-ing needs. sAirflow with cuff inflatedAre you a ventilatoruser or health professional with a question about home mechanical ventilation?

5 Send it to IVUN will find experts toanswer are currently finishing a yearstudy testing whether music is effec-tive for anxiety self-management forpatients throughout the duration ofreceiving mechanical ventilation inthe ICU and if these patients havelower stress levels when encouragedto listen to preferred music when-ever they like for as long as they like each day they are on a ventilator inthe ICU. While we are awaiting the finalresults, patients who have participatedin the study have conveyed that theyindeed feel relaxed and enjoy listen-ing to music they prefer, including thebenefits of wearing headphones toreduce some of the noise in the ICU,which also assists with overall goal of my work is to provide a complementary interven-tion to the medical plan of care tobring some comfort and relaxation to patients receiving mechanical ven-tilation in the ICU.

6 I am extremelygrateful to those patients and familymembers who have participated inmy many studies over the years. sMusic Helps Reduce Stress and Anxietycontinued from page 3