Respiratory muscle dysfunction secondary to chronic tracheostomy tube placement

In patients requiring periodic mechanical ventilation, a deflated, fenestrated tracheostomy tube may impair respiratory muscle performance during spontaneous breathing. We describe a patient with severe chronic airflow obstruction (CAO) whose respiratory muscle performance and exercise duration improved after tracheostomy tube removal. Duty cycle, Pdi/Pdi max, and the tension time index were all lower during exercise after tracheostomy tube removal. We conclude that a deflated and fenestrated tracheostomy tube significantly increases airways resistance and can further limit ventilatory muscle performance in patients with airflow obstruction. Patients requiring intermittent ventilatory support may benefit from permanent tracheostomy fistulas that allow for intermittent self cannulation. This would avoid loading of the respiratory muscles when breathing spontaneously.