Subglottic suctioning
Efficient secretion management in tracheostomy patients
Blockable tracheostomy tubes are necessary for invasively ventilated patients to prevent leakage via the upper airways and/or for patients with severe dysphagia to protect the lower airways.
![[Translate to English:] Mensch auf türkisem Hintergrund mit subglottischer Trachealkanüle](/fileadmin/_processed_/f/0/csm_Subglottische_Absaugung_37a9e4ccd0.jpg)
In tracheotomised patients who are fitted with a blockable tracheostomy tube without subglottic suction, tracheal suction is performed exclusively below the blocked cuff. Secretions which collect above the cuff can only be aspirated without the subglottic suction device when the cuff is unblocked. A tracheal cannula with subglottic suction is advantageous for shortening the tracheal suction process and thus minimising mucosal irritation and injury in the trachea. This measure can also prevent ventilator-associated pneumonia1. This also applies to tracheal suctioning during the unblocking process, e.g. as part of speech therapy. Even with a blocked tracheostomy tube with a cuff pressure between 20 and 30 cm H²O, microaspiration of contaminated subglottic secretions into the deep airways cannot be ruled out. Regular subglottic aspiration of secretions can therefore reduce the risk of pneumonia.
In addition to the advantage that the secretions can be removed for pneumonia prophylaxis, the subglottic suction device also offers the option of air insufflation. This gives the patient the potential for phonation (above cuff vocalisation, ACV for short) and thus "mimics" unblocking of the cuff. In the speech therapy setting, air insufflation can be a preparation for later unblocking attempts and can, for example, have a positive effect on sensitivity and swallowing frequency.2
More on the topic of secretion management
Sources:
1Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) (2013). Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsblatt, 56:1578-1590
2Niers, N. Subglottische Luftinsufflation bei tracheotomierten PatientInnen. Logos, Jg. 27, Ausg.2:96-102. 2019.
