From the Guidelines
A T-tube circuit is not directly related to tracheostomy care, but rather a breathing system used during anesthesia, however, in the context of tracheostomy, a similar concept of a breathing circuit is used, and the most recent evidence suggests that patients with a tracheostomy tube should be maintained with a closed circuit while on mechanical ventilation 1. When considering the care of a patient with a tracheostomy, it is essential to understand the basic anatomy of the trachea and its relationship to adjoining structures, as well as the rationale for tracheostomy and the status of the airway in the patient 1. The key elements of tracheostomy care include:
- Explaining the basic anatomy of the trachea and its relationship to adjoining structures
- Explaining the rationale for tracheostomy and the status of the airway in the patient
- Demonstrating counting of respiratory rate and apical heart rate
- State actions to be taken in the event of tube obstruction, accidental decannulation, and bleeding
- Demonstrating CPR, including bag-to-tracheostomy ventilation and mouth-to-mouth with stoma occlusion
- Understanding the importance of humidification and method of delivery
- Assessing the need for suctioning and demonstrating proper technique for suctioning, cleaning the inner cannula, and cleaning suction equipment
- Assembling supplies and demonstrating a tracheostomy tube change
- Understanding the principles of skin care, including keeping the skin clean and dry and avoiding pressure necrosis
- Discussing and implementing safety measures, including avoiding dust, smoke, lint, pet hair, powder, sprays, small toys, and objects. In terms of the T-tube circuit, the most recent evidence suggests that a closed circuit should be used while on mechanical ventilation with a tracheostomy tube, and in-line suction should be used 1. It is also essential to be aware of the monitoring needs, if prescribed, and to be able to operate the monitor correctly and act on the information, as well as to be aware of the projected decannulation plan and to discuss the plans for follow-up care 1. Overall, the care of a patient with a tracheostomy requires a comprehensive approach that includes understanding the basic anatomy, explaining the rationale for tracheostomy, demonstrating proper techniques for tracheostomy care, and implementing safety measures, with the most recent evidence suggesting the use of a closed circuit while on mechanical ventilation 1.
From the Research
T-Tube Circuit
- A T-tube circuit is used in mechanical ventilation, particularly during the weaning process 2.
- The T-tube circuit is compared to pressure support ventilation (PSV) in terms of weaning success, intensive care unit (ICU) mortality, reintubation, ICU and long-term weaning unit (LWU) length of stay, and pneumonia 2.
- Studies have shown that there is no clear evidence of a difference between PSV and T-tube for weaning success, ICU mortality, reintubation, ICU and LWU length of stay, and pneumonia 2.
- However, PSV was found to be significantly superior to the T-tube for successful spontaneous breathing trials (SBTs) among patients with simple weaning 2.
Ventilator-Associated Pneumonia (VAP)
- VAP is a serious complication of mechanical ventilation, with high morbidity, mortality, and costs 3, 4.
- The use of a T-tube circuit may be associated with a lower risk of VAP, as seen in studies comparing sedation protocols and their effects on VAP incidence 5.
- However, the relationship between T-tube circuits and VAP is not directly addressed in the provided studies.
Sedation Protocols
- Sedation protocols, including the use of midazolam, propofol, and dexmedetomidine, may affect the incidence of VAP and the duration of mechanical ventilation 6, 5.
- A nurse-implemented sedation protocol was found to decrease the rate of VAP and the duration of mechanical ventilation 5.
- The use of dexmedetomidine alone may be associated with a lower risk of VAP and in-hospital mortality, compared to other sedation regimens 6.