Cuff tightness in the trachea

[TRLESH]

Hi All! I am hoping someone has a clue about my post and can offer some helpful suggestions.

My mom has been on a trach/vent since July 2009. Since then she has had three trach changes for various reasons. The first trach was fine - size 8 Shiley. We got it changed in December and since then she has had nothing but problems with tightness between the cuff and her trachea. The amount of air that needs to come out of the cuff so it isn't tight allows air to escape and sets off the vent alarm for "low pressure". When I fill the cuff until the leaking stops, she tells me it is too tight.

Her ear, nose, throat specialist is suggesting a size 6 Shiley but I wonder if that will do any good. She still will need a certain amount of air in the cuff to prevent leaking and I have a feeling no matter what size the trach tube is, sealing the leak is going to be too tight for her. I'm kind of at my wits end with this. After the December trach change, the ENT changed it again and she was good for about a day and a half, then the same problems cropped up again...so it wasn't the trach itself. I wish I knew how it was supposed to feel with the cuff in her trachea so I could understand better if what she is feeling is normal or if she is just complaining.

Her pulmunologist has given up and said everything looks stellar so the best he can do is give her something for her discomfort which equates to injectable lidocaine and vicodin. Can this really be the only solution?

I'm all "eyes" for suggestions here...and thank you in advance!

Tracy

 

[joelc]

Tracy, I am sorry for the problems she is having. I have a cuffless trache tube so really don't know what to say.
I don't understand why the low pressure alarm is going off when the pressure it reduced in the cuff. I never have that problem and I don't have a cuff so something is wrong there.
Something is definitely not right. Maybe try another ENT and pulmonary doctor.

 

[TRLESH]

Hi Joel!

I'm confused....how can you have a cuffless trach tube while on a vent? The cuff is supposed to prevent the leakage of air around the trach tube so it doesn't go up through your nose and mouth, but keeps the pressure going to your lungs.

 

[joelc]

This is the difference between the USA and Canada. I have had this conversation many, many times.
I want the leakage of air as it allows me to be able to talk. It took me almost 1 day to get used to how to deal with the air. It is just like holding your breath. After 1 day I was doing it unconciously. Not a big deal at all.

The biggest reason for a cuff is to prevent aspiration. If a person has swallowing problems a cuff is necessary. I didn't.

 

[Amatop]

Hi Tracy. I would say to consult another pulmonologist or even a respiratory therapist. It may just be that she has to get used to it... It does surprise me that you have only changed the trache 3 times since she has had it. We change mom's out every month. It sucks to have it changed out so much and she hates it of course but it has gotten easier as time has gone by. My mom went on a vent on Apr 16, 2007. We were told that it needs to be changed out so often so the skin does not attach itself to the trache tube. I wish I could have been more help and I do hope that you can find someone who has a trache to help answer your questions.

 

[LauraW]

Tracy...this is right up my alley. Mom had soooo many trache changes in the beginning. Very very scarey at times and she spent most of the time in the hospital. We finally found the perfect one. It is a Shiley 7 xt with a cuff. Do you have a respiratory therapist who specializes in ALS? Is there a clinic near you? Mom never complained of her trache being too tight because of the cuff but I do sometimes have to put air in . The only time we let it out is to suction her well...sometimes saliva gets stuck at the cuff area. She uses her suction machine a lot. I wonder if it is anxiety your mom is feeling. Does she get a lot of saliva? You can let the air out if she does not have this problem (like Joel) but her vent settings would have to be changed. What happens when you let air out...is your Mom uncomfortable or is it just that the vent goes crazy? If your Mom is fine then I would tell someone and have them change the vent settings. Just some thoughts. Let me know what happens please.