From the Guidelines
Yes, patients with a tracheostomy can experience volume loss due to increased insensible fluid losses as air bypasses the upper airway. This occurs primarily because the air enters directly into the trachea without passing through the nose and mouth, resulting in greater evaporative losses from the respiratory tract. The provided evidence 1 does not directly address the issue of volume loss in patients with a tracheostomy, but it highlights the importance of a coordinated approach to caring for these patients and the need for multidisciplinary teamwork, standardization, education, and patient partnership to improve patient safety and quality of care. However, based on general medical knowledge, patients with tracheostomies require adequate hydration to compensate for these increased losses, often needing an additional 10-15 mL/kg/day of fluid. Signs of volume depletion include thick, tenacious secretions, crusting around the tracheostomy site, and difficulty clearing the airway. Using a heat and moisture exchanger (HME) or heated humidification system can significantly reduce these fluid losses. Regular assessment of hydration status through monitoring urine output, skin turgor, mucous membrane moisture, and laboratory values is essential for patients with tracheostomies to prevent complications related to volume depletion. Some key points to consider in the management of patients with a tracheostomy include:
- The need for adequate hydration to prevent volume depletion
- The use of humidification systems to reduce fluid losses
- Regular monitoring of hydration status to prevent complications
- The importance of multidisciplinary teamwork and standardization in caring for patients with a tracheostomy.
From the Research
Tracheostomy and Volume Loss
- Patients with a tracheostomy (trach) may experience various complications, but there is limited direct evidence on volume loss specifically due to the tracheostomy procedure 2, 3, 4.
- However, studies suggest that tracheostomy patients may have feeding disorders, which can lead to malnutrition and potentially affect their volume 5.
- Tracheostomy is often performed on patients who require long-term mechanical ventilation, and the procedure can help alleviate upper airway obstruction and prevent laryngeal damage 6.
- While there is no direct evidence on volume loss, tracheostomy patients may experience complications such as infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula, which can indirectly affect their overall health and potentially lead to volume loss 2, 3, 4.