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Saturday, May 21, 2011

Inflated or Deflated?

Respiratory therapist, S.S., asks, "If the patient has been weaned from the ventilator, should the cuff be inflated or deflated?

Answer: The inflated cuff provides a seal of the airway in order to effectively ventilate and oxygenate the patient.  When the patient no longer requires the ventilator, it is usually best to deflate the cuff because of other problems that an inflated cuff can cause (tracheomalacia, tracheal stenosis, etc.).  However, the exception to this rule is the patient who cannot protect his airway.  Those who pose a risk for aspiration should have an inflated cuff because their cough and/or swallow reflex is not strong enough to prevent secretions from entering the airway.

When patients require cuff inflation, we need to ensure that the cuff is inflated enough to prevent leakage around the cuff, but not exert too much pressure against the trachea.  Measured cuff pressure should be in the range of 20-25 cm H2O.

In the absence of  measured cuff pressure, a good clinical technique is minimal leak technique.  In this case the cuff is completely deflated (first, use a soft suction catheter to remove secretions from the oropharynx), then inflated until a leak is no longer heard.  At that point, 1/2 ml of air is withdrawn from the cuff, enough to seal the airway, but minimizing excess pressure against the trachea.

It is important to note that clinical opinion varies on this point.  If the patient is in the ICU and managed by the critical care team, their goal is to ventilate the patient and may not be as concerned with high cuff pressures in the short term.  However, to prevent more long term complications, it is wise to minimize cuff pressure as much as clinically warranted.

2 comments:

  1. I work in long term care as a Respiratory Therapist & I recently had a disagreement with a co worker about cuff inflation while on trach collar. My thought process is that if they aren't on a vent their cuff should be deflated due to possible trach occlusion except in cases where extreme aspiration is an issue. She had a patient on trach collar was having difficulty maintaining sats above 90%. First she had her on the trach collar & a nasal cannula then she changed her trach from uncuffed to cuffed, inflated the cuff & left her on trach collar! When I asked her why she did that she stated that (as if like the
    patient was on a vent) inflating the cuff would allow her to get larger volumes in her lungs because there wouldn't be any air leakage around the trach. That answer left me wondering if she went to RT school! What is your opinion on that scenario?

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  2. I completely agree with you while on a tracheostomy collar and not on ventilator support
    And unless there is an aspiration risk why keep
    The tracheostomy cuff inflated.

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