Once daytime mouth IPPV was mastered, body ventilators could be used for nocturnal support with the tracheostomy tube plugged. Body ventilator use not only facilitated tracheostomy site closure by relieving the stoma of the positive expulsive pressure which occurs during positive pressure assisted ventilation, but early use of a body ventilator also facilitated training in mouth IPPV by alleviating fear of dyspnea during early trials.
Mouth IPPV normalized speech rhythm, provided normal daytime ventilation, and permitted “air stacking” for volitional sighing, shouting, and assisted coughing. The change to a fenestrated tracheostomy tube often improved the efficacy of mouth IPPV as well as the effectiveness of body ventilator use with the tracheostomy tube plugged and the cuff deflated. It also improved speech volume while on mouth IPPV or on free time whenever possible. The fenestration of the commercially available tubes, however, was at times malpositioned against the posterior tracheal wall where invagination of the tracheal mucosa into the fenestration rendered it ineffective and caused bleeding while exacerbating granulation formation. Proper positioning of the fenestration was accomplished by ordering a custom made fenestrated tube or changing to a smaller sized tube. buy antibiotics online
5. Patients were advanced to the use of cuffless tracheostomy tubes. The great majority of patients did not require a tracheostomy diameter change to maintain optimal ventilation and speech volume; however, ventilator volumes often needed to be as much as doubled to compensate the increased leakage.
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