Home ventilator low-pressure alarms fail to detect accidental decannulation with pediatric tracheostomy tubes

Background: Positive-pressure ventilators are equipped with low-inspiratory -pressure alar ms to protect patients from hypoventilation. Small uncuffed tracheostomy tubes have a high resistance, and may not trigger these alarms during decannulation. Study objective: To determine whether ventilator low-inspiratory-pressure a larms are effective in detecting tracheostomy decannulation. Design: We connected tracheostomy tubes of varying inner diameters (3.0 to 6.0 mm) to a home ventilator and simulated decannulation using lon (tidal v olume [VT], 600 mL; peak inspiratory pressure [PIP], 25 cm H2O), medium (VT , 800 mL; PIP, 30 cm H2O), and high (VT, 1,000 mL; PIP, 35 cm H2O) ventilat or settings. Results: When the ventilator low-inspiratory-pressure alarm was set at 4 cm H2O below the desired PIP, it failed to alarm for simulated decannulation of tracheostomy tubes < 4.5 mm on low and medium settings, and < 4.0 mm on high settings. When the ventilator low-inspiratory-pressure alarm was set a t 10 cm H2O below the desired PIP, it failed to alarm with tracheostomy tub es < 6.0 mm. Conclusion: We conclude that ventilator low-inspiratory-pressure alarms fai l to alarm during simulated decannulation with small tracheostomy tubes com monly used in children. We speculate that low-inspiratory-pressure alarms s et at 4 cm H2O below the desired PIP will detect more decannulation than wh en set at 10 cm H2O below the desired PIP.