Category Archives: Chronic Tracheostomy

Tracheostomy Tube Placement. Instruction Given By Canadian Health and Care Mall

Pulmonary functionPulmonary function is shown in Table 1. There was severe obstructive lung disease with an FEV/FVC ratio of 44 percent. No significant changes were noted in lung volumes or arterial blood gas measurements with the tracheostomy tube, Montgomery button, or after tracheal stoma closure. Airways resistance measured at the mouth, was very high with the fenestrated deflated tracheostomy tube in place (7.55 cm H20/L/s). It decreased by 43 percent with placement of the Montgomery button and reached its lowest value with tracheostomy stoma closure (2.94 cm H20/L/s). Exercise endurance increased by 400 percent with decannulation and stoma closure (Table 2). This was associated with an increase in minute ventilation (17.5 to 19.9 L/min) at similar oxygen uptake (8 ml/kg/min). Respiratory muscle function measured during ergometry is shown in Table 3. The Pdi max at end exercise decreased 40 percent with the tracheostomy tube in place, 27 percent with the Montgomery button, and 13 percent after tracheostomy closure. The Pdi/Pdi max recorded during exercise was reduced after stoma closure and also with the Montgomery button. The duty cycle (Ti/T tot) was highest during exercise with the tracheostomy tube in place. It was less with the Montgomery button and lowest after tracheal revision. The tension time index (Pdi/Pdi max x Ti/Ttot) was decreased after stoma closure compared to that observed with the tracheostomy tube in place. The contribution of gastric pressure to the generation of Pdi max at end exercise was greatest after removal of the tracheostomy tube.