title: Effect of tracheostomy tube on work of breathing: Comparison of pre- and post-decannulation.
abstract: OBJECTIVE
  To describe and compare the work of breathing (WOB) during spontaneous breathing under four conditions: (1) breathing through a tracheostomy tube with an inflated cuff, (2) breathing through the upper airway (UA) with a deflated cuff and occluded tube, (3) breathing through the UA with an occluded cuffless tube, and (4) postdecannulation.
  
  
  METHODS
  Patients who tolerated an occluded cuffless tube were included. Ventilatory variables and esophageal pressure were recorded. The pressure-time product (PTP), PTP/min, and PTP/min/tidal volume (PTP/min/VT) were measured. Each condition was measured for 5 min with a 15 min time interval between evaluations. Quantitative data are expressed as mean ± standard deviation. Single-factor analysis of variance was used, and the Games-Howell test was used forpost hocanalysis of comparisons between group means (P≤ 0.05).
  
  
  RESULTS
  Eight patients were studied under each of the four conditions described above. Statistically significant differences were found for PTP, PTP/min, and PTP/min/VT. In thepost hocanalysis for PTP, significant differences among all conditions were found. For PTP/min, there was no significant difference between Conditions 2 and 4 (P= 0.138), and for PTP/min/VT, there was no significant difference between Conditions 1 and 2 (P= 0.072) or between Conditions 2 and 3 (P= 0.106). A trend toward a higher PTP, PTP/min, and PTP/min/VT was observed when breathing through a cuffless tracheostomy tube.
  
  
  CONCLUSIONS
  The four conditions differed with respect to WOB. Cuff inflation could result in a reduced WOB because there is less dead space. Cuffless tracheostomy tubes generate increased WOB, perhaps due to the material deformity caused by body temperature.
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Darío
authors.initials: D
authors.lastname: Villalba
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Viviana
authors.initials: V
authors.lastname: Feld
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Valeria
authors.initials: V
authors.lastname: Leiva
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Mariana
authors.initials: M
authors.lastname: Scrigna
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Distéfano
authors.affiliation: Respiratory Care Sevices, Sanatorio Anchorena, CABA, Buenos Aires, Argentina.
authors.forename: Romina
authors.initials: R
authors.lastname: Pratto
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Rodriguez
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Jesica
authors.initials: J
authors.lastname: Collins
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Ana
authors.initials: A
authors.lastname: Rocco
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Amelia
authors.initials: A
authors.lastname: Matesa
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Damián
authors.initials: D
authors.lastname: Rossi
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: Areas
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Sacha
authors.initials: S
authors.lastname: Virgilio
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Golfarini
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Gil-Rosetti
authors.affiliation: Cabinet Support the Production of Hospital Information, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Diaz-Ballve
authors.affiliation: Department of Respiratory Care, Clínica Basilea, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Planells
keywords: Airway care; airway extubation; artificial airway; decannulation; extubation methods; tracheostomy; work of breathing