We have admitted a new patient with a Shiley Trach connected to continuous suction. The trach has a suction port positioned above the cuff. I cannot find information regarding this trach. Only information on the Shiley Trach-Talk, which looks strangely similar.

Thank you.

The only trach I know of with a suction port above the cuff is the Portex suctionaid. I have seen people use talking trachs that have external gas flow, used as a above the cuff suction device, but it tends to work poorly.

I haven't seen any Shiley trach with succion port, but your device seems very similar to the HiLo Evac EndoTrachTube. It has a succion port above the cuff in order to reduce VAP. In a local study (I do not have the e-copy, sorry...) done at Sacré-Coeur Hospital in Montréal, Evac ETT in conjonction with raising the head of the bed by 30 degrees, reduced VAP by 30%.

The procedure is simple (and is mandatory if you don't want the succion port to block): Keep a contiuous succion of -20 cmH2O, and every 2-4 hours, inject slowly 5 cc of air (not saline) to verify patency.

The Evac EET is also used in my hospital (level one trauma center) for long terme ventilation (> 48 hrs) and transfers (trauma, neuro, etc.)

Hope this helps.

Hello
The Shiley trach with subglottic suction port is new and can be reviewed on the website. Similar to the Portex model.

A couple of thoughts on the HiLo Evac tube.
In 2003, they recommended to maintain lumen patency with injection of 10cc sterile water if lumen blocked.

http://www.tycohealth-ece.com/files/d0001/ty_0efefo.pdf

As Renton describes, present recommendations include -20 continuous sx or -100 intermittent with injection of free air if lumen blocked.

http://www.nellcor.com/prod/Product.aspx?id=162

Canadian 2004 guidelines support its usage in conjunction with other strategies for VAP management. Our centre (the other Level 1 Trauma centre in Montreal) does not use them to my chagrin since our ICU is full of supine head traumas who aspirated a bucket before they even were intubated. Reason: cheap, cheap and cheaper. Some centres use them on all patients, for them I offer these 2 links:

http://www.anesthesia-analgesia.org/cgi/reprint/105/4/1083

and this one:

http://cat.inist.fr/?aModele=afficheN&cpsidt=1127069

This system is unknown to me though I would agree it should likely operate similar to the HILO EVAC tube.

Invariably we are using EVAC tubes per the VAP recommendations as well as head elevation to 30 degrees. The suction level is set at -ve 20 and we clean the lumen with air rather than saline. This choice was made in hopes of not adding more volume of secretions to the layrnx. It is important with these tubes to be diligent in clearing and checking the inner lumen as they seem to easily become blocked.

The general concensus here is that because the block so easily they are worthless. Because of the merit on the VAP study we persist with them.

I wonder if Shiley has found a suitable solution to the blockage issue. Best of luck and thankyou CdnRT for the websites.

We have been using the HiLo ETT in our hospital since 2003 and have yet to have one of the suction port block. The key is the constant suction of no more than 20mmHg suction and to bolus the port with 10cc of air every 4 hours. We also use the Blueline suctionaid trach for all of our long term vent patients and have had no issue with them. currently we have had only 3 VAP since 2005 (defining a VAP according to the NHSN guidelines) and the 3 VAP that we have had 1 came in without the HiLo ETT and the other 2 didn't receive the Blueline suctionaid trach.