Can oxygen be adequately provided via a tracheostomy (tracheal opening with a tube) stoma?

Oxygen Delivery via Tracheostomy Stoma

Yes, oxygen can be adequately provided via a tracheostomy stoma, and it is the recommended route for oxygen delivery in patients with tracheostomy. 1

Oxygen Delivery Methods for Tracheostomy Patients

Primary Oxygen Delivery Options

• In patients with tracheostomy, oxygen is predominantly delivered via a tracheostomy mask, which is a variable performance device capable of delivering oxygen concentrations up to 60-70% 1
• If higher oxygen concentrations are required, a T-piece device fitted directly to the tracheostomy tube should be used 1
• For patients requiring emergency oxygenation through a stoma, a pediatric facemask or supraglottic airway device applied over the stoma attached to a bag-valve mask can be effective 1

Humidification Requirements

• Humidification is essential when delivering oxygen via tracheostomy as the tube bypasses the patient's natural mechanisms to warm and moisturize inspired gases 1
• Proper humidification helps maintain a patent tracheostomy tube, reduces secretion buildup, and minimizes patient discomfort 1
• Bubble bottles should not be used for humidification as there is no evidence of clinical benefit and they pose an infection risk 1

Advanced Oxygen Delivery Options

High-Flow Oxygen Therapy via Tracheostomy

• High-flow oxygen therapy via tracheostomy (HFOTTRACHEAL) can be used and provides several benefits:
  • Slightly increases PaO2/FiO2 ratio at higher flow rates (50 L/min) 2
  • Reduces respiratory rate without PaCO2 changes 2
  • Provides a small degree of positive airway expiratory pressure 2
• At 50 L/min flow rate, HFOTTRACHEAL can improve oxygenation and respiratory mechanics compared to standard oxygen therapy 2

Self-Made Delivery Devices

• Research has shown that specialized tracheostomy oxygen delivery devices can provide advantages such as secure connection to the tracheostoma, adjustable oxygen concentration, and air filtration 3

Clinical Considerations and Pitfalls

Potential Complications

• Inadequate humidification can lead to:
  • Buildup of secretions within the inner tube or tracheostomy 1
  • Potential tube obstruction 1
  • Patient discomfort 1

Special Considerations

• When a patient deteriorates and requires increased oxygen concentration exceeding what a variable performance interface can deliver (60-70%), switch to a T-piece device fitted directly to the tracheostomy tube 1
• For patients with prolonged mechanical ventilation needs, high-flow oxygen via tracheostomy may facilitate weaning in those with restrictive pulmonary dysfunction 4
• The upper airway may need to be occluded when delivering oxygen via the stoma to prevent air leakage and ensure effective ventilation 1

Emergency Situations

• In emergency situations, if the patient is breathing spontaneously via the tracheostomy tube or open stoma, oxygen should be applied directly to that site 1
• If ventilation via the upper airways is not possible or inadequate, ventilation should be attempted via the stoma 1
• For rescue breaths in emergency situations, high-flow oxygen should be delivered via the stoma if the upper airway is obstructed 1

By following these guidelines, oxygen can be adequately and safely delivered via a tracheostomy stoma, with appropriate attention to humidification, delivery method, and potential complications.