10/24/2026
Some of the most important details in tracheostomy management aren’t always obvious at first glance. 🫁
1. Partial displacement can be more dangerous than complete decannulation.
A tracheostomy tube can move out of the trachea and into the surrounding soft tissue while still appearing attached at the neck. If positive pressure is delivered through a malpositioned tube, air may enter the surrounding tissues instead of the lungs. This is why a tube that appears flush externally isn’t necessarily correctly positioned internally.
2. An inner cannula can significantly affect airflow.
Reinserting an inner cannula reduces the available internal diameter of the tube. Even a 1 mm reduction matters particularly with smaller tubes because airflow resistance increases significantly as diameter decreases. Inner cannulas can substantially increase resistive work of breathing depending on tube design and size.
3. Fenestrations can become sites of granulation tissue growth.
Fenestrated tubes allow airflow toward the upper airway to support vocalization. However, granulation tissue can grow around or into these openings, potentially obstructing airflow, causing bleeding, or complicating tube exchanges.
4. Positive-pressure ventilation through a cuffless tracheostomy can be challenging.
Without a cuff seal, delivered air can escape around the tube and out the upper airway rather than reaching the lungs effectively. During respiratory or cardiac arrest, significant leakage makes effective ventilation difficult without alternative occlusion techniques or a cuffed tube swap.
These details are reminders that tracheostomy management involves far more than the tube itself.
Understanding the relationship between tube position, airway diameter, tissue mechanics, and airflow is essential to bedside safety.
What’s one tracheostomy lesson you think every clinician should know? 👇
CriticalCare ClinicalEducation | RespiratoryTherapist | TracheostomyCare | Tracheostomy