We are a small facility, 12 bed CCU that occasionally provides long term ventilatory support. There are lack of facilities to provide long term care or rehab in our state so they stay in our CCU.
We seem to find that inevitably, they end up with significant cuff leaks that lose delivered volume. The trend is to add a little more air to the cuff to try and get better seal (higher cuff pressure but no seal).
We discussed this today and are thinking to focus on exhaled volume, not delivered volume. So, increase VT, set tighter high pressure alarms, and low exhaled volumes alarms.
What is your experiences with these situations. Over the past few years, we've tried various trachs without success (foam cuff, Mallickrodt's tracheosoft XL distal/proximal trachs, as well as various sizes.
Thank you for your feedback!
Karen

I work at a chronic/rehab facility in Toronto, Ontario.
We let them leak during the day to fascilitate speach. We use one way valves in line and put the cuffs down. Some pts need their Vt increased with this. We use transcutaneous monitoring and SpO2's to adjust for good numbers. At night we reduce Vt's and put cuffs up. We us Bivona tubes that are TTS (tight to shaft) cuffs.
Pts who cannot tolerate cuffs down.........we use shileys with them the LPC (low pressure cuffs).....again if they can tolerate a leak (SpO2's and TcPCO2's) we let them leak a bit. Some pts dont like leaking.....they dont like the feel of it. But the added ability to speak gets them over it....:)
Hope this helps.

I have run into this before...one client stands out in my mind. ALS...huge air leak..darn near fistula....with cuff pressures off the manometer.

We put a bivona foam in-line with the Servo. If memory serves me correct, the only time it inflated was during an simv breath. Otherwise it remained inflated just to the foam width.

Email me if you need more specifics....cgneureka@aol.com

Good luck!