Tracheostomy Care

A tracheostomy brings the environment of the lower airway directly to inspired air. The nose and upper airway normally warm, filter, and humidify that air; a tracheostomy bypasses those functions. Without added humidification, mucus becomes viscous, ciliary movement and mucociliary transport decline, and secretions can form a plug inside the tube. That sequence is more than discomfort. Retained secretions promote microatelectasis and infection, increase the work of breathing, and can obstruct the only route for ventilation. Humidification is therefore a required part of routine tracheostomy care, not an optional comfort measure. A cuffed tube adds another risk. Its inflated cuff seals against the tracheal wall for positive-pressure ventilation, but the seal is not a guarantee against aspiration. Excessive pressure compresses tracheal capillaries and causes mucosal ischaemia; sustained or repeated over-inflation can contribute to tracheal stenosis, tracheomalacia, tracheo-oesophageal fistula, or tracheoinnominate fistula. Insufficient pressure permits air leakage and microaspiration of secretions around the cuff. Cuff pressure must be measured, not estimated by palpating the pilot balloon.