Cuffed vs uncuffed trachy - can anyone explain? - ICUsteps

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Cuffed vs uncuffed trachy - can anyone explain?

Kit10 profile image
Kit10

In my memories of being in ICU sometimes I could speak with difficulty and sometimes not at all.

Someone stated to explain that it depends whether the trachy is cuffed or uncuffed but then her pager bleeped and she had to go.

I think she was saying, when you’re ventilated through it, it is cuffed and you can’t speak, when they’re trying to wean you off it it’s uncuffed and you can talk, though only in a whisper.

Can anyone clarify? Did I understand her correctly? Can anyone add more details?

Kit

5 Replies

My understanding is very basic. Cuffed means the lungs are still under positive pressure - I think this is so we don’t aspirate on all the junk - our lungs aren’t strong enough yet. It means no air passes over the vocal chords because the cuff is inflated which is like a balloon. Uncuffed means we can speak - and louder with a passé muir valve.

Sepsur is correct. There is something like an inner tube round the internal part of the trachy which when inflated (cuff up) seals the gap round the trachy.

Since posting this a colleague of the woman I spoke to dropped in to see me and showed me a tracheotomy tube and showed me how the cuff works. I found it really helpful to see it. There are lots of pictures if you Google “tracheotomy tubes”. And click on “images”. The one I saw was clear plastic, with a right angle bend in it, about six inches long in total. The cuff looks a bit like a bubble wrap bubble, inflated and deflated using a syringe.She explained that when the cuff is inflated air can only go through the trachy and down to the lungs, or vice versa, when it’s deflated some air can go past the vocal chords and out through the mouth so you can speak but not very loudly.

She said they would have deflated it when trying to get me to breathe for myself but reinflated it when they gave up that and put the ventilator back on, and as that happened a few times, yes my voice would have come and gone, and yes there probably was a physiotherapist who adjusted it to let me talk, and yes I probably did lose my voice overnight because the deflated cuff gets gunged up with secretions and has to be cleaned out.

Wow!

Thanks to Jane for that.

Kit

Hit, I had a trachy and was sometimes able to have a 'speaking valve's put in so I could talk a little . This was when I was starting to come off the meds and only gor short periods of time as talking was tiring. X

Kit10 profile image
Kit10 in reply to Sleepalotmore

Hi SleepalotmoreYes, I got a speaking valve after a while. She explained how that works too.

(For anyone reading this who doesn’t know, when you breathe out it closes the trachy tube so all the air goes over the vocal chords and out through the mouth so you can speak almost as normal apart from the first bit of breath it takes to close the valve.)

It took a little while to get the hang of it but it was a huge plus to be able to speak. Except they kept taking it out without warning me. When I protested (using gestures, and no, not rude ones) I got a little lecture about infection control, then they said I could have it back in the morning, and walked away. I think that was thoughtless to the point of cruel. I am still very angry about that.

They could have said “We need to take it out soon, anything you’d like to say first?” It would have cost approximately nothing and been SOOO much better for my welfare.

The first thing I tried to say was “Hello World” but the people around me didn’t hear what I said, so I tried “It’s good to talk” and they laughed.

Kit

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