• The ordinary Chevalier Jackson silver tracheostomy tube, without inflatable cuff, is easier to insert than is the soft rubber tube with inflatable cuff. The silver tube offers less resistance, the depth of its insertion is better controlled, there is no worry about the possibility of gradual deflation, and there is less danger of trauma to the tracheal mucosa from the constant pressure of the cuff.
The silver tube must be used with a high-capacity, intermittent positive-pressure respirator that can compensate for the leakage up through the larynx. Five makes of respirator have been found usable in this connection. The leak protects against excessive pressure in the lungs and blows pharyngeal secretions up toward the mouth.
The air supplied must be humidified. Accidental disconnections must be prevented. The tracheotomy per se has hazards and complications, but when it is required there are advantages in eliminating the tank respirator and using positive-pressure respiration.
Mörch ET, Saxton GA, Gish G. ARTIFICIAL RESPIRATION VIA THE UNCUFFED TRACHEOSTOMY TUBE. JAMA. 1956;160(10):864–867. doi:10.1001/jama.1956.02960450046011
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