Cuffed versus Cuffless Tracheostomy Tubes

cuffed versus cuffless tracheostomy tube

What is a cuffed tracheostomy tube?

Tracheostomy Tube parts

A tracheostomy tube may be either “cuffed” or “cuffless (uncuffed).”  A cuffed tracheostomy tubes has a balloon-like feature at the distal end of the tube.  There are three main types of cuffs:  low-pressure cuffs, low-volume cuffs and foam-filled cuffs.  The cuff can be inflated or deflated with air or water depending on which type of cuff is present.  


For more information on patients with COVID-19 and tracheostomy and mechanical ventilation please see our article, COVID-19 Tracheostomy and Mechanical Ventilation.  

Types of cuffed tracheostomy tubes

High Volume-low Pressure Cuffs

Cuffed tracheostomy tube

Cuffs with a high volume have low-pressure and are called “high volume low-pressure cuffs.”  As per manufacturer recommendation,  Bivona Aire-Cuf (Smiths Medical North America, Dublin, Ohio) and Shiley cuffs (Covidien, Mansfield, Massachusetts) should be inflated with air only.

High volume-low pressure cuffs are generally dual cannula tracheostomy tubes.  Dual cannula tubes have an inner cannula and an outer cannula.  Because of the large volume, a larger surface area is in contact with the tracheal wall, which lowers the incidence of damaging the tracheal mucosa.    However, these cuffs occupy a large amount of space when the cuffs are deflated during ventilator weaning.  The resistance from the cuff may result in difficulty exhaling through the upper airway when the cuff is deflated or difficulty tolerating a speaking valve or cap.