Clinical Question

In patients with a tracheostomy (+/- mechanical ventilation), does an inflated cuff exacerbate / increase aspiration of food or fluids at the level of the vocal folds compared to a deflated cuff?

Critically Appraised Topic

In non-ventilated patients with tracheostomy, there are mixed results on whether aspiration of food or fluid is exacerbated or increased by the presence of an inflated cuff.   There were no studies in mechanically ventilated patients that answered the clinical question.   In the non-ventilated cohort two small studies were identified, one suggested an increased risk, the other reported no increased risk in aspiration with cuff up when evaluated on MBS.  We are not able to conclusively report either way on whether cuff status increases the risk of aspiration. PDF Format

Critically Appraised Papers

Davis, D.G., Beras, S., Barone, J.E., Corvo, P.R. and Tucker, J.B. (2002). Swallowing with a tracheotomy tube in place: Does cuff inflation matter? Journal of Intensive Care Medicine, 17(3), 132-135.

Effects of Cuff Deflation and One-Way Tracheostomy Speaking Valve Placement on Swallow Physiology. Dysphagia 18; 284-292 (2003).