What is the difference between cuffed and uncuffed trachs?

  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

Tracheal stenosis

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.   Screen Shot 2018-10-25 at 8.18.23 PM.png


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