title: Home ventilator low-pressure alarms fail to detect accidental decannulation with pediatric tracheostomy tubes.
abstract: 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.
  
  
  OBJECTIVE
  To determine whether ventilator low-inspiratory-pressure alarms are effective in detecting tracheostomy decannulation.
  
  
  METHODS
  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 H(2)O), medium (VT, 800 mL; PIP, 30 cm H(2)O), and high (VT, 1,000 mL; PIP, 35 cm H(2)O) ventilator settings.
  
  
  RESULTS
  When the ventilator low-inspiratory-pressure alarm was set at 4 cm H(2)O 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 H(2)O below the desired PIP, it failed to alarm with tracheostomy tubes < 6.0 mm.
  
  
  CONCLUSIONS
  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 H(2)O below the desired PIP will detect more decannulation than when set at 10 cm H(2)O below the desired PIP.
authors.affiliation: Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Kun
authors.forename: C T
authors.initials: CT
authors.lastname: Nakamura
authors.forename: J F
authors.initials: JF
authors.lastname: Ripka
authors.forename: S L
authors.initials: SL
authors.lastname: Davidson Ward
authors.forename: T G
authors.initials: TG
authors.lastname: Keens
mesh_terms: D002648:Child; D004868:Equipment Failure; D006701:Home Nursing; D006801:Humans; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D014139:Tracheostomy; D012122:Ventilators, Mechanical