Uses
Advantages
Disadvantages
Unfenestrated
- Patients receiving positive pressure ventilation
- Patients who are at high risk of aspiration
- Creates a channel to allow delivery of positive pressure ventilation
- Protects the lungs from gastric and upper airway secretions
- Can still allow for vocalisation through deflation of the cuff
- Little or no voicing occurs when the cuff is inflated
- Increases airflow resistance compared to unfenestrated tubes, particularly when tube is capped
Fenestrated
- Spontaneously breathing patients imminently approaching decannulation (useful when unable to manage capping of unfenestrated tube)
- Generally not recommended when cuff inflation is still required to protect the airway from aspiration
- Allows maximum airflow to upper airway for voicing when tracheostomy occluded (speaking valve or cap)
- Allows some airflow to vocal cords for speech even when cuff inflated
- Reduces airflow resistance and work of breathing when appropriately sited
- May still be used for positive pressure ventilation if an unfenestrated inner cannula is placed (not recommended in newly formed stoma as air may still leak around fenestrations, risking surgical emphysema)
- Fenestrations increase the risk of oral or gastric contents entering the lungs
- Positive pressure ventilation will result in air leak and should be avoided where possible
- There is a risk of surgical emphysema in patients with newly formed tracheostomies
- May stimulate granuloma formation around the fenestrations
- Requires placement of an unfenestrated inner cannula when undertaking suctioning