Page 189 - Clinical Application of Mechanical Ventilation

Airway Management in Mechanical Ventilation 155

use of this type of tube delays the early onset of ventilator-associated pneumonia
(Valle et al., 1995) and prevents nosocomial pneumonia in intubated patients
(Mahul et al., 1992).
Intubation through the nostril is better tolerated by the patient. It provides an
ideal access to the lower airway in conditions where oral access is limited. The nasal
Disadvantages of nasal route of intubation may be preferred for trismus (lockjaw), oral trauma or deformi-
intubation include difficulty
to insert, use of a smaller ET ties, mandible fracture, and short neck.
tube, and potential develop- The disadvantages of nasal intubation include difficulty to insert, use of a smaller
ment of sinusitis.
ET tube, and potential development of sinusitis.

Tracheostomy Tube

A tracheostomy tube is inserted through a surgical opening into the trachea. In
The decision to change long-term mechanical ventilation, it is used to replace the ET tube that has been in
from an ET tube to a
tracheostomy tube is based place for 21 days or longer (Shapiro et al., 1991).
on the patient’s condition and
prognosis. The tracheostomy tube bypasses the upper airway and the glottis and therefore
avoids any potential injury in these areas and offers lower airflow resistance. It is also
easier to maintain, stabilize, and suction. In addition, the patient can eat and drink
with the tracheostomy cuff properly inflated (Shapiro et al., 1991).
Tracheostomy tubes are not without drawbacks. Since a tracheostomy tube
is inserted through a surgical opening, infection and trauma to the surgical site
are always a threat. To reduce the potential complications of tracheostomy, sterile
Sterile technique must be and aseptic techniques must be followed during tracheostomy care and suctioning
followed during tracheostomy
tube care and suctioning. (White, 2002).

Specialty Tracheostomy Devices

There are two main types of tracheostomy tubes: cuffed and cuffless. Both cuffed
and cuffless tubes are available with or without inner cannulas. Disposable tracheo-
sotmy tubes are made of PVC plastic or silicone. Reusable tubes are made of silver
or stainless steel. Specialty tracheostomy tubes are also available to suit different
patient requirements. Some examples are discussed below.

Talking tracheostomy tube. Trach-Talk™ Tracheostomy Tubes (Portex, 2011) was
designed to assist the patient to speak in a low whispered voice. With the cuff
inflated, a gas line with a thumb port is connected to a gas source (air or oxygen).
The flow of gas is set from 4 L/min to 6 L/min. When the thumb port is occluded,
the gas passes through the vocal cords making phonation possible.
Speaking valves are adaptors used on a regular tracheostomy tube that make pho-
nation possible without the need of a constant gas flow. Speaking valves will be
discussed later in this chapter.

Tracheostomy tube with high volume-low pressure cuff. The high volume-low pressure
cuff (e.g., Bivona Fome-Cuf ®) uses a silicone foam material to fill the cuff. This

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