Cuffed shiley vs ETT

[Multifidus]

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What do you all prefer in a patient with a tracheostomy? My case is a 400#er with an old trach originally done for COPD and Severe OSA. Now with sepsis related to an epidural abscess. We're going prone....I get to do the 3hr thoracic lami. Evidently the patient is stable on t-collar now. I haven't seen the patient yet, but let's assume there is an uncuffed Shiley in situ.

In the past I have both had pulm place a cuffed Shiley and I have placed an ETT in the stoma (both regular and wire reinforced). I don't like placing Shileys because I just haven't placed a lot of them and am not really familiar with the sizing (diameter and length). What do you all usually do. My plan is to place a Cook or Aintree cather in the uncuffed Shiley prior to removing it, and then guiding a wire reinforced ETT over the catheter. But I feel a cuffed Shiley may be easier to secure in place for a prone case in a morbidly obese patient and reduce the risk of kinking. Any thoughts?

Thanks

 

[TrustMe]

I like ETT in these cases. Especially if they are prone. Just make sure the circuit is supported and the tube is secured well. If they have had this for a while you shouldn't have to worry about exchange catheter stuff. Just go to sleep, pull out shiley, stick in ETT. Done.

 

[HalO'Thane]

I also like the ETT (wire reinforced or non-wire) for longer cases and cases going prone. Doing peds, I often have to determine the appropriate sized ETT that correlates with their trach. A useful tip is to determine the OUTER diameter of the patient's trach and use an ETT with a similar sized outer diameter.

 

[BDanes]

I agree w above. I have no doubts about good seal w my ETT. The last thing I want is any guesswork/hoping on a prone airway, least of all a morbidly obese one.

Anesthesia for me is all about reducing my own stress level.

 

[VentdependenT]

as long as you dont mainstem. no reason for a cuffed trach to not work.

 

[deleted9493]

Yeah, I'm all about the wire-reinforced tubes here. I'll also drop a couple of dermal stay sutures to provide an angle on the tube so that gravity is not pulling directly on the tracheal os...oh yeah, a big tegarderm over the site, as well.

 

[Idiopathic]

Yeah, I'm all about the wire-reinforced tubes here. I'll also drop a couple of dermal stay sutures to provide an angle on the tube so that gravity is not pulling directly on the tracheal os...oh yeah, a big tegarderm over the site, as well.

all of this

 

[IlDestriero]

I don't really understand all the fuss. I change out uncuffed for cuffed trachs all the time. Unless it's brand new or there are known complex airway issues (like compression requiring a custom extra long trach) it's as easy as 1-2-3. A properly secured cuffed trach is just as good as an ETT. That's all it really is, a very short cuffed tube with a built in curve. The only advantage I see with an ETT would be that it's probably easier to suction in a patient with known secretion problems while in the prone position. Though I think the trach is more secure. What problems have you had with a prone trach?

 

[deleted9493]

I don't really understand all the fuss. I change out uncuffed for cuffed trachs all the time. Unless it's brand new or there are known complex airway issues (like compression requiring a custom extra long trach) it's as easy as 1-2-3. A properly secured cuffed trach is just as good as an ETT. That's all it really is, a very short cuffed tube with a built in curve. The only advantage I see with an ETT would be that it's probably easier to suction in a patient with known secretion problems while in the prone position. Though I think the trach is more secure. What problems have you had with a prone trach?

Agreed, for a typical patient. I have only done this in the obese, as in the case presented.