|Cuffed trach||Uncuffed trach||Fenestrated trach (comes with a cuff)|
|Indication||Patients on a closed ventilator (cuff prevents airleak)||Patients who are more stable, getting closer to decannulation||Patients on a ventilator who aren’t ready for a speaking valve. Has a cuff but is more “in-between”|
|Compatible with speaking valve?||
Yes—must deflate the cuff first
Yes, speaking valve may not be necessary
No—if cuff is deflated can speak using vocal cords or a trach plug
|Advantages||Provides the most secure airway||Is easier for the patient to tolerate||Allows air to pass more “normally” through nose and mouth|
|Things to look out for||Pressure necrosis
|Cuffless or deflated cuffs are more prone to silent aspiration||Many fit poorly, leading to granuloma formation and infection|
|Random things to know||Cuff pressures are ideally checked twice a day: 20-30 mmHg generally good||The decannulation plug is used when patients get decannulated, so hold on it it||Patients can still wear a nasal cannula if the trach is plugged|
The table above was made using this Hopkins page as a reference.
This guide from OHSU is seriously fantastic. (Except at the beginning I think they switched the labels for pilot line and cuff.) I am shamelessly borrowing their pictures.