Influence of the Cuff Pressure on the Swallowing Reflex in Tracheostomized Intensive Care Unit Patients

Amathieu, R.; Sauvat, Stéphane; Reynaud, P.; Slavov, V.; Luis, David; Dinca, Andrei; Tual, L.; Bloc, Sébastien; Dhonneur, Gilles

doi:10.1097/01.sa.0000433229.28518.b8

Cited by 5 publications

(5 citation statements)

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“…15 A common myth is that an inflated cuff decreases the risk of aspiration, but an inflated cuff can actually increase the risk of aspiration. 16,17 It has been demonstrated that the inflated cuff anchors the trachea to the anterior part of the neck and results in reduced movement of the larynx and obstruction of the esophagus. [17][18][19][20] Suiter et al 21 demonstrated that deflation of the cuff reduced risk of aspiration of liquids and improved laryngeal excursion.…”

Section: Ten Steps Toward Decannulationmentioning

confidence: 99%

“…16,17 It has been demonstrated that the inflated cuff anchors the trachea to the anterior part of the neck and results in reduced movement of the larynx and obstruction of the esophagus. [17][18][19][20] Suiter et al 21 demonstrated that deflation of the cuff reduced risk of aspiration of liquids and improved laryngeal excursion. Amathieu and colleagues 17 demonstrated that the swallowing reflex was progressively more difficult to elicit with increasing cuff pressure.…”

Section: Ten Steps Toward Decannulationmentioning

confidence: 99%

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The Importance of Tracheostomy Progression in the Intensive Care Unit

Morris

McIntosh

Whitmer

2014

Critical Care Nurse

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T racheostomy is now considered a common procedure, 1 and so it is important for nurses to become knowledgeable about tracheostomy progression, beginning immediately postoperatively and continuing through long-term care. Most tracheostomies placed in patients in intensive care units (ICUs) are done in order to facilitate weaning from mechanical ventilation. After the patient has been liberated from mechanical ventilation and the need for the tracheostomy is resolved, there should be a plan to progress toward decannulation. Daily evaluation of the progress toward decannulation can reduce length of stay, infection rates, and overall health care costs. [2][3][4][5] In this article, we review a systematic method for tracheostomy progression and describe how critical care nurses can facilitate this process. FeatureA plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient's ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications. (Critical Care Nurse. 2014;34[1]:40-50) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss a systematic method for tracheostomy progression 2. Describe how critical care nurses can facilitate the process of decannulation 3. List outcomes achieved with a standardized clinical practice guideline for tracheostomy patients

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Section: Ten Steps Toward Decannulationmentioning

confidence: 99%

Section: Ten Steps Toward Decannulationmentioning

confidence: 99%

The Importance of Tracheostomy Progression in the Intensive Care Unit

Morris

McIntosh

Whitmer

2014

Critical Care Nurse

View full text Add to dashboard Cite

show abstract

“…In addition to the increased potential for airway injury with higher cuff pressures, the swallowing reflex is more difficult to elicit with increasing cuff pressure, and when activated, the resulting motor swallowing activity and efficiency in elevating the larynx are depressed. 14 A common cause of high cuff pressure is that the tube is too small, resulting in overfilling of the cuff to achieve a seal in the trachea. Another common cause of high cuff pressure is malposition of the tube (eg, cuff inflated in the stoma).…”

Section: Tracheostomy Tube Cuffsmentioning

confidence: 99%

Tracheostomy TubesDiscussion

Hess

Altobelli

2014

Respir Care

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“…There are many opportunities to explore how other aspects of care for the tracheostomized patient can be improved, including the development of strategies to increase mobility and to improve communication or swallowing [20][21][22][23]. Recent studies have examined the role of multidiscplinary tracheostomy teams for reducing complications, especially following the discharge of patients with tracheostomies to the ward [24,25].…”

Section: Management Of Patients After Tracheostomymentioning

confidence: 99%

What’s new with tracheostomy?

Scales

2013

Intensive Care Med

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Influence of the Cuff Pressure on the Swallowing Reflex in Tracheostomized Intensive Care Unit Patients

Cited by 5 publications

References 0 publications

The Importance of Tracheostomy Progression in the Intensive Care Unit

The Importance of Tracheostomy Progression in the Intensive Care Unit

Tracheostomy TubesDiscussion

What’s new with tracheostomy?

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