Does Cuff Design Impact Insertion and Removal Force of Tracheostomy Tubes? A Bench Model

Abstract

Introduction Percutaneous dilatational tracheostomy is a commonly performed procedure in intensive care units. Unrecognized tracheal ring fracture has been suggested as a possible factor for tracheal stenosis. The degree of tracheal compression relates to the amount of force required to cannulate the trachea. The objective of this study was to determine the force required to insert two types of tracheostomy tubes with different cuff designs. Materials and Methods This bench model measured the insertion and removal force of two tracheostomy tubes; one with a barrel-shaped, high-volume, low-pressure cuff (traditional Shiley tracheostomy tube) and another with a taper-shaped, low-volume, low-pressure cuff (Shiley flexible tracheostomy tube). Three sizes of tracheostomy tubes either with a barrel- or taper-shaped cuff were tested (Jackson sizes 4, 6, and 10, corresponding to 6.5-, 7.5-, and 10-mm ISO sizes, respectively). A model representing the tissue that the tube traverses to enter the tracheal lumen was designed, and the tracheostomy tube was mounted on a universal testing machine to measure the force necessary to insert and remove the tube. Results Across all tracheostomy tubes’ sizes tested, significantly less force was required to insert the Shiley flexible tracheostomy tube compared to the traditional Shiley tracheostomy tube. Significantly less force was also required to remove the flexible tracheostomy tube compared to the traditional tracheostomy tube. Conclusions This model suggests that less force is required to insert the Shiley flexible tracheostomy tube, which could result in less tracheal compression. This may be because of the smaller taper-shaped cuff that, when deflated, occupies less volume compared to the barrel-shaped cuff. As a result, less tracheal injury may occur when using the Shiley flexible tracheostomy tube during percutaneous tracheostomy procedures.