Key Differences Between Jackson and Shiley Tracheostomy Tubes
Jackson and Shiley tracheostomy tubes differ fundamentally in their material composition, design features, and clinical applications—Jackson tubes are rigid metal tubes with inner cannulas primarily used in specialized circumstances like post-laryngeal reconstruction, while Shiley tubes are flexible polyvinyl chloride (PVC) tubes that represent the modern standard for most tracheostomy patients.
Material Composition and Structural Design
Jackson Tubes
- Rigid metal construction 1
- Include an inner cannula that reduces the internal diameter, which can lead to excessively high airway resistance, particularly problematic in small children 1
- Lack a standard 15-mm universal adapter for emergency bag ventilation, requiring workarounds such as connecting to an appropriately sized endotracheal tube connector 1, 2
- Oldest design still in use, valued for ease of use and cost-effectiveness 2
Shiley Tubes
- Flexible polyvinyl chloride (PVC) construction 1
- MRI-safe (all Shiley models) 3
- Greater length, shorter radius of curvature, and rougher inner surface compared to Jackson tubes 4
- Include standard 15-mm universal adapter for emergency ventilation 1
- Available with or without inner cannulas depending on model
Clinical Performance Differences
Airflow Resistance and Work of Breathing
Jackson tubes demonstrate significantly lower flow resistance and reduced power of breathing compared to similar gauge Shiley tubes 4. This difference stems from the Shiley tube's greater length, shorter radius of curvature, and rougher inner surface 4. Both tube types show differences in flow resistance between inspiratory and expiratory phases 4.
Practical Clinical Implications
- Jackson tubes are reserved for special circumstances, such as serving as an Aboulker stent after laryngeal reconstruction 1
- Shiley tubes are the standard choice for most pediatric and adult tracheostomy patients
- The inner cannula in Jackson tubes, while useful for patients with thick copious secretions (allowing cleaning without frequent tube changes), creates additional airway resistance 1
Selection Considerations Based on Guidelines
The American Thoracic Society guidelines 1 emphasize that tube selection should prioritize:
- Proper fit: The distal portion must be concentric and colinear with the trachea to avoid complications including esophageal obstruction, tracheal wall erosion, tracheo-innominate artery fistula, and stomal breakdown
- Flexibility needs: Silicone tubes conform better to airway shape when standard PVC tubes don't provide optimal fit 1
- Emergency preparedness: All tubes should have 15-mm universal adapters—a critical limitation of metal Jackson tubes 1
Common Pitfalls
- Avoid Jackson tubes in small children due to excessive airway resistance from the inner cannula 1
- Do not assume all tubes are MRI-compatible: Shiley PVC tubes are MRI-safe, but always verify specific model compatibility 3
- Recent Shiley design changes (2021) introduced a "duckbill" inner cannula configuration that creates air leak during finger occlusion phonation, requiring modification for patients who prefer this communication method 5
- Tube size matters more than technique: Size 8 Shiley is associated with significantly reduced complication rates (P = .002) 6
Modern Clinical Practice
In contemporary practice, Shiley tubes dominate routine tracheostomy care, while Jackson tubes persist only in highly specialized scenarios where their rigid metal construction provides specific advantages, such as maintaining airway patency after laryngeal reconstruction 1. The choice between these tubes fundamentally reflects the evolution from rigid metal devices to flexible synthetic materials that better accommodate patient anatomy and modern ventilation equipment.