What Is the Difference Between a Cuffed and an Uncuffed Tracheostomy Tube?

What is the difference between a cuffed and an uncuffed tracheostomy tube?

Tracheostomy tubes come in different types for different purposes and patient needs, and they also come in different sizes depending on the patient's requirements. 

Cuffed tubes are ideal for patients who require mechanical ventilation. These tubes have a cuff, or balloon: one balloon sits outside the tube, and another inflates inside the airway. Whatever we do to the outside balloon also happens to the inside one, since that is the only way we can control what is happening inside the airway. For a patient who requires mechanical ventilation, we need to keep this balloon inflated at all times, because it seals the airway and allows mechanical ventilation; otherwise, whatever we are giving the patient will not reach them if there is a leak. When checking on patients, it is important to ensure the balloon stays inflated, as it can partially deflate over time. For that reason, we always keep a syringe at the bedside so we can reinflate it as needed.

Cuffed tubes allow sustained and effective positive pressure ventilation, because the cuff seals the airway, preventing gas from escaping above the tracheostomy tube. The cuff also helps prevent aspiration, which is important since many patients have a large amount of secretions.

Uncuffed tubes do not have a cuff on the inside or the outside. These are ideal for patients who can breathe independently. In other words, if the patient no longer requires ventilation and can breathe on his own but still needs the tracheostomy tube in place, we use an uncuffed tube. Uncuffed tubes help reduce the risk of tracheal damage from cuff inflation and are used in patients who require ongoing suctioning to clear secretions.

This Ask the Expert is an edited excerpt presented by Zhanna Sorin, BSRT, RRT.