Home ventilator low-pressure alarms fail to detect accidental decannulation with pediatric tracheostomy tubes.
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.
Kun
S S
SS
Division of Pediatric Pulmonology, Childrens Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027, USA.
Nakamura
C T
CT
Ripka
J F
JF
Davidson Ward
S L
SL
Keens
T G
TG
D002648:Child; D004868:Equipment Failure; D006701:Home Nursing; D006801:Humans; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D014139:Tracheostomy; D012122:Ventilators, Mechanical