Evidence and alternatives to the routine use of cuffed tracheostomy tubes in spontaneously breathing patients with neurological disorders

Introduction: Cuffed Tracheostomy tubes (TT) are often used in spontaneously breathing patients with neurological impairment because of a high risk of aspiration. Besides to the well-known risks, cuffed TT impair cough efficiency and therapeutic strategies for the treatment of dysphagia. Methods: A PRISMA-based systematic review of MEDLINE, PubMed and Cochrane examined the available evidence on cuffed tracheostomy tubes in spontaneously breathing, neurologically impaired adult patients and summarized key findings and alternatives to their routine use. Results: The studies-mostly clinical reports and narrative reviews-describe in-house treatment strategies to minimize tracheal damage caused by cuffed TT. No RCTs were found that prove the benefit of cuffed TT in patients with a high risk of aspiration. Conclusion: The current data does not support the routine use of cuffed TT in non-ventilated patients with neurological impairment and a high risk of aspiration. Prospective studies are required to compare the benefit of cuffed vs. cuffless TT in this population to prevent aspiration pneumonia.