Comparison of five types of tracheostomy tubes in the intubated trachea

Recognition of excessive cuff pressures as a major factor in tracheal injury has prompted the development of different types of cuffed tracheostomy tubes. Five brands of tracheostomy tubes in common use are evaluated in anesthetized adult dogs. Visualization of interior tracheal conditions during spontaneous and positive pressure ventilation permits a dynamic study of the trachea and its interaction with each tube under varying conditions. The relationship between intracuff pressure and cuff-tracheal wall pressure is analyzed for each tube. The selection of the proper tracheostomy tube for a given clinical situation should consider: 1) the cuff pressure necessary to achieve minimal leak, 2) torque transmission, 3) the ability to monitor cuff-tracheal wall pressure as a function of intracuff pressure, and 4) simplicity of design for optimum clinical use. Tracheal expansion occurs in a predictable fashion in response to different stimuli. However, the role of expansion in the susceptibility of this organ to injury remains to be investigated.