R.H. asks, "We have a tracheostomy patient who is being airlifted to a different facility in another state. Should we have any concerns with air transport?"
Answer: The biggest concerns with transport of any kind is dislodgement. So the usual precautions for ensuring tube security should be in place. These include ensuring snugness of the trach ties and limiting traction against the tube. However, air transport poses additional concerns with cuffed tracheostomy tubes. Boyle's law states that a fixed volume of gas will expand as pressure decreases. So when the cuff is inflated with air, barometric pressure will decrease with altitude, and cuff pressure will rise as the cuff expands. Studies have measured cuff pressures of well over 200 cm water pressure during air transport!
The usual clinical methods of ensuring safe cuff pressure--namely, minimal occlusive volume and minimal leak technique, are ineffective in air transport because the noise level is too high. Some recommend using saline to inflate the cuff, but there are no devices currently on the market that will continuously monitor and automatically adjust cuff pressure.
For a detailed discussion on this topic, see Chapter 5 in Tracheostomies: The Complete Guide.
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