Tracheostomy tube type and inner cannula selection impact pressure and resistance to air flow

Pryor, Lee N., Baldwin, Claire E., Ward, Elizabeth C., Cornwell, Petrea L., O'Connor, Stephanie N., Chapman, Marianne J. and Bersten, Andrew D. (2016) Tracheostomy tube type and inner cannula selection impact pressure and resistance to air flow. Respiratory Care, 61 5: 607-614. doi:10.4187/respcare.04396

Author Pryor, Lee N.
Baldwin, Claire E.
Ward, Elizabeth C.
Cornwell, Petrea L.
O'Connor, Stephanie N.
Chapman, Marianne J.
Bersten, Andrew D.
Title Tracheostomy tube type and inner cannula selection impact pressure and resistance to air flow
Journal name Respiratory Care   Check publisher's open access policy
ISSN 0020-1324
Publication date 2016-05-01
Year available 2016
Sub-type Article (original research)
DOI 10.4187/respcare.04396
Open Access Status Not Open Access
Volume 61
Issue 5
Start page 607
End page 614
Total pages 8
Place of publication Irving, TX United States
Publisher Daedalus Enterprises
Language eng
Formatted abstract
BACKGROUND: Advancements in tracheostomy tube design now provide clinicians with a range of options to facilitate communication for individuals receiving ventilator assistance through a cuffed tube. Little is known about the impact of these modern design features on resistance to air flow.

METHODS: We undertook a bench model test to measure pressure-flow characteristics and resistance of a range of tubes of similar outer diameter, including those enabling subglottic suction and speech. A constant inspiratory ± expiratory air flow was generated at increasing flows up to 150 L/min through each tube (with or without optional, mandatory, or interchangeable inner cannula). Driving pressures were measured, and resistance was calculated (cm H2O/L/s).

RESULTS: Pressures changed with increasing flow (P < .001) and tube type (P < .001), with differing patterns of pressure change according to the type of tube (P < .001) and direction of air flow. The single-lumen reference tube encountered the lowest inspiratory and expiratory pressures compared with all double-lumen tubes (P < .001); placement of an optional inner cannula increased bidirectional tube resistance by a factor of 3. For a tube with interchangeable inner cannulas, the type of cannula altered pressure and resistance differently (P < .001); the speech cannula in particular amplified pressure-flow changes and increased tube resistance by more than a factor of 4.

CONCLUSIONS: Tracheostomy tube type and inner cannula selection imposed differing pressures and resistance to air flow during inspiration and expiration. These differences may be important when selecting airway equipment or when setting parameters for monitoring, particularly for patients receiving supported ventilation or during the weaning process.
Keyword Airway resistance
Ventilator weaning
Work of breathing
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Health and Rehabilitation Sciences Publications
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