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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 top 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.