Leakage Characteristics of Dual-Cannula Fenestrated Tracheostomy Tubes during Positive Pressure Ventilation: A Bench Study

Abstract

This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive pressure ventilation. Fenestrated Portex5 Blue Line Ultra5, TRACOE5 twist, or Rüsch5 Traceofix5 tracheostomy tubes equipped with nonfenestrated inner cannulas were tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration leakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures, temperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial differences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were <3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal tube design was the main factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of fenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises the risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema.

Practical Aspects About Tracheostomy Cannula: A Systematic Review

“…Selected studies dated from 1963 to 2016 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . Table I shows general description of the included studies and provides information regarding the original cited data (table I).…”

“…Tracheostomy tubes are made from polyvinylchloride or polyurethane, and inner tubes are made from polypropylene. These materials are thermoplastics: they expand and become more pliable as temperature rises 10,14 . At body temperature, the leakage rates of these tracheostomy tubes diminishes to less than 1% 10 .…”

“…The reinforcement acts as a support structure for the tracheostomy cannula and protects the tracheostomy fixed cannula from buckling and bending [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . Metallic tracheostomy cannulas are constructed of silver or stainless steel 7 .…”

“…They all have the same 90º curve-angle and diameters, independently on the brand, based on the Jackson sizing system 7 . The only difference on metallic tracheostomy cannulas are their sizes, which can be short, standard and long [4][5][6][7]10,14 .…”

“…In this case it is also recommended to change the metallic tracheostomy cannula into an equivalent plastic one 10 . Nonetheless, if the CT will be performed in a distant place from head, neck and torso, it will not interfere in the image.…”