Can a Patient with a Trach Use an Incentive Spirometer?
Yes, patients with tracheostomy can and should use incentive spirometry with appropriate adaptation—specifically, the device must be connected directly to the tracheostomy tube rather than used via the mouth, and this has been shown to improve lung volume and peak expiratory flow rates safely.
Evidence for Use
The most recent and highest quality evidence demonstrates that volume-oriented incentive spirometry is both feasible and effective in tracheostomy patients. A 2024 study showed that patients with cuffed tracheostomy tubes who performed incentive spirometry achieved mean lung volumes of 950 ± 330.9 mL and mean peak expiratory flow rates of 134.7 ± 63.3 after seven days of therapy, with minimal complications 1. This directly addresses morbidity by preventing atelectasis and improving pulmonary function, which are critical outcomes for quality of life in tracheostomy patients.
Technical Requirements
Device Adaptation
- The standard spirometer mouthpiece cannot be used because the patient breathes through the tracheostomy, not the mouth
- An adapter must connect the spirometer directly to the tracheostomy tube 2, 3
- These adapters have been successfully designed, tested, and received FDA investigational device exemption 3
- The connection must be hermetic (airtight) to ensure accurate measurements 4
Patient Selection Criteria
Appropriate candidates include:
- Adult patients with cuffed tracheostomy tubes
- Medical Research Council (MRC) score >48 (indicating adequate muscle strength)
- Ability to follow commands and participate in therapy 1
Clinical Implementation
Protocol
Based on adapted American Academy of Respiratory Care guidelines 3:
- Frequency: 3-4 sessions per day
- Duration: 6-10 breaths per session initially
- Training: Initial supervised sessions are essential to ensure proper technique
- Monitoring: Track volumes achieved and patient tolerance
Cuff Management Considerations
While the guidelines emphasize keeping cuffs inflated during mechanical ventilation weaning 5, for incentive spirometry exercises in stable patients not on ventilators, the cuff status should be determined by:
- Patient's ability to tolerate cuff deflation
- Risk of aspiration
- Need for upper airway participation in breathing exercises
Safety Profile
The evidence demonstrates excellent safety:
- Minimal complications in clinical studies 1, 3
- Most common issues: mild tracheostomy site pain (4/30 patients), transient hypotension (3/30 patients) 1
- No serious adverse events reported
- Device well-tolerated by patients 3
Clinical Benefits
Incentive spirometry in tracheostomy patients addresses critical morbidity concerns:
- Prevents atelectasis - a major complication in immobilized patients with altered respiratory mechanics 2
- Improves lung function - particularly important in patients with extensive surgical resection or chest wall deformity 2
- Enhances weaning potential - by maintaining and improving respiratory muscle strength
- Reduces pulmonary complications - especially relevant given many tracheostomy patients have underlying lung disease from smoking 4
Common Pitfalls to Avoid
- Do not attempt to use standard mouthpiece spirometers - they will not work and may frustrate patients
- Do not skip training sessions - proper technique is essential for effectiveness and safety
- Do not use in patients with unstable airways or those requiring continuous mechanical ventilation with inflated cuffs 5
- Do not force exercises if patient develops pain, dyspnea, or hemodynamic instability - these are signals to stop and reassess 1
Integration with Tracheostomy Care
Incentive spirometry should be incorporated into the broader tracheostomy management plan:
- Can be performed alongside other respiratory therapies
- Should not interfere with necessary suctioning or cuff management 5
- Timing should avoid periods immediately after tracheostomy changes or when secretions are excessive
- Consider as part of weaning protocol once patient tolerates cuff deflation 5
The evidence strongly supports that with proper adaptation and patient selection, incentive spirometry is not only possible but beneficial for tracheostomy patients, directly improving outcomes related to pulmonary function and reducing complications.