What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

Abstract

Objective This study aimed to determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy.Methods We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer.Results For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH<sub>2</sub>O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH<sub>2</sub>O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types.Conclusion Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

Inner Lumen Tracheostomy Tube Capable of Continuous Monitoring of Cuff Pressure

“…Tracheostomy has been used for more than 2000 years and developed and progressed by now [ 1 ] that this procedure changed since 1909. The incision in the tracheostomy procedure should be made below the second tracheal ring to prevent adverse events under the second layer of the tracheal ring to prevent adverse events to the extent possible [ 1 , 2 ]. In the past, the most common indication of tracheostomy was obstruction of the upper airway caused by infectious diseases.…”

“…However, insufficient distension of the tracheostomy tube cuff (less than 18 cm of H 2 O) results in aspiration of the secretions in the upper airways. To prevent the occurrence of such complications, the pressure inside the cuff should be recorded at appropriate time intervals and minimum pressure should be provided with an appropriate volume [1][2][3]. Currently, to determine whether the tube cuff is filled, the outer cuff balloon is touched and estimation is used, which are not reliable and accurate at all, even if done by skilled and professional individuals [4].…”

Impact of Low‐Volume, Low‐Pressure Tracheostomy Cuffs on Acute Mucosal Injury in Swine

“…3 The ideal cuff inflation pressure to minimize both tracheal injury and aspiration as a consequence of improper sealing correlates with tracheal capillary perfusion pressure. 4,5 Laryngotracheal stenosis at the cuff site was a major complication in the 1960s when low-volume, high-pressure cuffs were employed in ETT and tracheostomy tubes. This occurred because high-pressure cuffs used surpassed the tracheal capillary perfusion pressure of 20 to 30 cmH 2 O.…”