- Should be chosen to suit the individual patient:
- Must be a multidisciplinary decision
- Type should be re-evaluated continually as patients needs may change
- Considerations include:
Secretion Management
- Tubes with sub-glottic suction port useful in patient with secretions. They are recommended as standard in critical care patients as part of standard VAP intervention bundle
- Cuffed tubes help prevent aspiration of secretions or gastric contents and should be used in patients that are unable to manage secretions
- Fenestrations increase the risk of oral or gastric secretions entering the lungs and should not be used in those at risk of aspiration
Abnormal Airway Anatomy
- Standard tubes may be unsuitable in abnormal anatomy
- Obese patients may require tube with extended proximal length (adjustable flange)
- Patients with fixed flexion deformity may not accommodate tubes with a fixed angulation
Airway Pathology
- Pathology such as tracheomalacia or granuloma formation may necessitate the use of a tracheostomy tube that has a longer distal length
Weaning and Vocalisation
- Patient who are being 'weaned' may benefit from tubes that are a uncuffed or smaller in size than initially inserted
- Allows greater gas flow, increased ease of vocalisation and laryngeal rehabilitation
Clinical Support
- Tubes with a cuff and without fenestrations are required to facilitate positive pressure ventilation
- Though single cannula tubes may necessitate disconnection from ventilation to clean the tube, they are generally recommended in critical care to reduce the risk of tube obstruction particularly as respiratory support reduces