Cuff Deflation

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Cuff Deflation for a Tracheostomy Tube

Deflating the cuff of the tracheostomy tube has many benefits for a patient with tracheostomy, but must be done with caution.  Cuff deflation is a necessary stage in the decannulation process.  In one study 95% (107/113) patients were able to achieve cuff deflation on the first attempt.  Medical stability, respiratory stability and the amount of above the cuff secretions (less than 1ml/hr) were the main indicators for successful cuff deflation (Pryor, L et al, 2016). 

For information specific for patients with COVID-19 for cuff deflation please see COVID-19 and Tracheostomy and Mechanical Ventilation. 

Purpose of the tracheostomy cuff

The purpose of the cuff is to maintain the air delivered from the mechanical ventilator to the lungs. The cuff fills the tracheal space around the tracheostomy tube to prevent airflow from escaping around the tube and through the upper airway.  Instead, airflow is directed through the tracheostomy tube, which allows the ventilator to control and monitor ventilation for individuals on mechanical ventilation.  Therefore, positive pressure ventilation can be applied more effectively when the cuff is inflated.  However, many individuals on mechanical ventilation can be managed with the cuff deflated or cuffless tracheostomy tubes.  

 

The tracheostomy cuff and aspiration

aspiration trach image scaled

Material above the cuff is already aspirated

  • Once the cuff is deflated, aspirated material can fall into the lungs. 
  • Material that pools on top of the cuff may result in inflammation of these tissues (Siebens et al, 1993) and has potential to colonize as a source of infection.  
  •  Cuffs do not form an airtight seal against the trachea wall, therefore allowing material to pass around the cuff and into the lower airways and lungs. 
Inflated cuffs may also impair swallow physiology.  See swallowing management for patients with tracheostomy for more information and our webinar, Evidence Based Swallow Evaluation for Patients with Tracheostomy and Mechanical Ventilation.