Shiley Flexible Adult Tracheostomy Tubes vs. Shiley DCT and FEN Tracheostomy Tubes

Tracheostomy can influence the work of breathing by introducing additional resistance to airflow through the native airway. In a 1996 study, Hussey and Bishop determined that the presence of a deflated cuff in the airway significantly increased the work of breathing and theorized that a lower profile cuff would introduce less resistance to airflow. Hussey and Bishop also demonstrated that the presence of fenestration reduced the work of breathing. Interestingly, the authors noted that when they tested a cuffless No. 8 tube, the required inspiratory pressures remained below 1 cm of water at all flow rates. These findings suggest that the majority of the observed resistance to airflow for the cuffed tubes was due to the floppy, deflated cuff. In recent years, next-generation tracheostomy tubes with a taper-shaped cuff have been developed. Evidence to date suggests that a taper-shaped cuff provides a better seal against the tracheal wall at lower cuff pressures than a traditional cylindrical cuff, resulting in reduced fluid leak across the cuff and a lower potential for tracheal injury from excess pressure. 3 Given the influence of cuff shape and fenestration on tracheal airflow, the purpose of this analysis was to evaluate airflow around the tube for a range of ShileyTM tracheostomy tubes. More specifically, ShileyTM Flexible tracheostomy tubes with a taper-shaped TaperGuardTM cuff were compared to predicate tubes with cylindrical cuffs, with and without fenestration.