Tracheotomy tubes

Standard high volume, low pressure cuff

Fenestrated with or without cuff

Useful where airway protection is not a primary concern. May be closed during normal breathing while providing intermittent suction access.

Fenestrated with inner tube

As above but with an inner tube to facilitate closure of the fenestration during intermittent mechanical ventilation.

Fenestrated with speaking valve

Inspiration allowed through the tracheostomy to reduce dead space and inspiratory resistance. Expiration through the larynx, via the fenestration, allowing speech and the advantages of laryngeal PEEP.

Adjustable flange

Accommodates extreme variations in skin to trachea depth while ensuring the cuff remains central in the trachea.

Pitt speaking tube

A non-fenestrated, cuffed tube for continuous mechanical ventilation and airway protection with a port to direct airflow above the cuff to the larynx. When airflow is directed through the larynx some patients are able to vocalise.

Passy-Muir speaking valve

This is an expiratory occlusive valve placed onto the tracheostomy tube that permits inspiration through the tracheostomy and expiration through the glottis. The tracheostomy tube cuff must be first deflated. The valve allows phonation, facilitates swallowing and may reduce aspiration. Small studies have suggested that it may reduce the work of breathing. The potential tidal volume drop through cuff deflation makes this valve only suitable in those patients requiring no (or relatively low level) invasive ventilatory support.

Silver tube

An uncuffed tube used occasionally in ENT practice to maintain a tracheostomy fistula.

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