Originally published on May 30, 2010 P.T. asks, "What is the purpose of downsizing?" Answer: The purpose of downsizing is to allow the patient to do more breathing around the tube, rather than through the tube. When the initial problem that initiated placement of the trach is resolved, downsizing may begin. For example, when the

Originally published on October 2, 2011 J.D. asks, "I heard that there are many benefits for capping a trach.  Can you explain?" Answer: Yes, capping a tracheostomy tube can provide many benefits; the primary benefit is usually allowing a patient to speak.  First, not all tracheostomy tubes should be capped.  A standard cuffed tracheostomy tube should never

Originally published on February 2, 2011 T.A. asks, "If a patient uses a cap or a valve in order to speak, should the cuff be inflated or deflated?" Answer: The purpose of the cuff is to seal the airway, and the ability to phonate depends upon air reaching the vocal cords.  So the ability to speak

Originally published on April 26, 2011 B.F. asks, "What is the usual progression of trachs?  My mom got her trach after being in the ICU on a ventilator.  Now she is off the ventilator...so what happens next?" Answer: The usual progression for tracheostomies depends upon the reason why it was initally placed.  For patients who

Originally posted on January 16, 2012 Decannulation failure is defined as the need to replace the airway after the tube has been decannulated. This Australian study examined 981 ICU patients who received tracheostomies.  Seventy-seven percent of them were placed percutaneously and 23% were placed surgically.  The mean duration of placement was 16 days.  A total of 823 decisions