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Laboratory and Animal Investigations |

Home Ventilator Low-Pressure Alarms Fail To Detect Accidental Decannulation With Pediatric Tracheostomy Tubes*

Sheila S. Kun, RN; Craig T. Nakamura, MD; James F. Ripka, RRT; Sally L. Davidson Ward, MD; Thomas G. Keens, MD, FCCP
Author and Funding Information

*From the Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Correspondence to: Thomas G. Keens, MD, FCCP, Division of Pediatric Pulmonology, Mailstop #83, Childrens Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027; e-mail: tkeens@chla.usc.edu



Chest. 2001;119(2):562-564. doi:10.1378/chest.119.2.562
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Background: Positive-pressure ventilators are equipped with low-inspiratory-pressure alarms to protect patients from hypoventilation. Small uncuffed tracheostomy tubes have a high resistance, and may not trigger these alarms during decannulation.

Study objective: To determine whether ventilator low-inspiratory-pressure alarms are effective in detecting tracheostomy decannulation.

Design: We connected tracheostomy tubes of varying inner diameters (3.0 to 6.0 mm) to a home ventilator and simulated decannulation using low (tidal volume [Vt], 600 mL; peak inspiratory pressure [PIP], 25 cm H2O), medium (Vt, 800 mL; PIP, 30 cm H2O), and high (Vt, 1,000 mL; PIP, 35 cm H2O) ventilator settings.

Results: When the ventilator low-inspiratory-pressure alarm was set at 4 cm H2O below the desired PIP, it failed to alarm for simulated decannulation of tracheostomy tubes < 4.5 mm on low and medium settings, and < 4.0 mm on high settings. When the ventilator low-inspiratory-pressure alarm was set at 10 cm H2O below the desired PIP, it failed to alarm with tracheostomy tubes < 6.0 mm.

Conclusion: We conclude that ventilator low-inspiratory-pressure alarms fail to alarm during simulated decannulation with small tracheostomy tubes commonly used in children. We speculate that low-inspiratory-pressure alarms set at 4 cm H2O below the desired PIP will detect more decannulation than when set at 10 cm H2O below the desired PIP.


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