Are Fenestrated Tracheostomy Tubes Still Valuable?

Abstract

Purpose The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.

Comparing Voice Related Quality of Life scores between fenestrated and speaking valve cannula users

“…6,13 The fenestrated tracheal cannula not only assesses the patient's capacity to breathe normally through the oral/nasal route (preparing the patient for decannulation), but also lets air to travel through the vocal cords, allowing phonation to occur. According to Pandian et al 11 study, fenestrated tracheal cannulas were infrequently utilized and were often reserved for certain situations. Malposition could irritate the tracheal mucosa, leading to the production of granulation tissue, tracheal stenosis, and tracheomalacia.…”

“…As a result, the appropriate position in the airway should be examined on a frequent basis. 11,14 During inhalation, the tracheal speaking valve opens, allowing external airflow to enter the airway through the valve opening. When the patient exhales, the valve closes, and the air is expelled through the upper airway from the tracheal cannula and tracheal space.…”

Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy

“…These tubes have often been reported to result in difficulties with granulation tissue and tracheomalacia and may increase the likelihood of errors in routine care related to inner cannula changes required for suctioning. 29 Using cuff deflation and a OWV in-line will enable laryngeal rehabilitation to begin. We advocate commencing 27 laryngeal weaning as early as possible, ideally prior to ventilator weaning, thereby promoting sensation and activation of muscles in and around the laryngeal complex, decreasing the risk of further muscle wasting.…”

“…These tubes have often been reported to result in difficulties with granulation tissue and tracheomalacia and may increase the likelihood of errors in routine care related to inner cannula changes required for suctioning. 29…”