Cuffed and Cuffless Tracheostomy Tubes
Patients who need ventilation (assisted breathing with a respirator or breathing machine) require tracheostomy tubes that are blocked and sealed by what is called a cuff (also called a balloon) located on the lower outer cannula. The cuff blocks any air from flowing around the tube and assures that the patient is well oxygenated. All the air must therefore flow in and out through the tube itself. A pilot tube attached to the cuff stays outside the body and is used to inflate or deflate the cuff.
A fenestrated tube has an opening (fenestration) in the back of the outer cannula. The front of the tube can be blocked which allows the air to flow upwards to the upper part of the trachea and larynx. A fenestrated tube allows the patient to breathe normally and to speak or cough through the mouth.
A fenestrated trach tube is often used as the final step before trach tube removal. It permits the patient to speak and cough on their own, providing an experimental trial for life after the trach tube.
Cuffless tubes are primarily used in non-ventilated patients that have no difficulty swallowing and have no danger of aspiration. Since there is no cuff, it allows air to pass into the upper trachea and larynx so the patient can cough and speak normally.
Cuffless tubes are usually worn over a long period of time so require a very accurate fit in order to prevent pressure sores in the trachea or at the tracheal stoma. For this reason, they are usually offered in many sizes and can also be custom-made.