PDF(Pubmed)
Abstract：
Patients with a Blom® tracheostomy tube (containing a cuff) can vocalize while on mechanical ventilation, which can significantly improve the patient\'s quality of life. This is brought by the purpose-built structure of the tracheostomy tube that allows the expiration to be expelled through the glottis. However, this characteristic may complicate the measurement of the patient\'s tidal volume, as most of the expiration does not return to the ventilator. Owing to the necessity of insertion of the speech cannula, which acts as an inner cannula, to enable patient vocalization, the air passage likely becomes constricted, thus increasing airway resistance. Difficulty in applying appropriate positive end-expiratory pressure (PEEP) and ventilator auto-triggering may also be problematic. Therefore, alveolar ventilation is predicted to decrease without adjusting the ventilation settings. Our experience using the Blom® tracheostomy tube revealed some problems, and we provide suggestions for patient management. We herein report on the experience of a patient having inserted the Blom® tracheostomy tube receiving mechanical positive pressure ventilation during vocal training.
摘要：
使用Blom®气管切开导管（包含袖带）的患者可以在机械通气时发声，可以显著提高患者的生活质量。这是由气管造口管的专用结构带来的，该结构允许通过声门排出呼气。然而,这种特性可能会使患者潮气量的测量复杂化，因为大部分过期不会回到呼吸机。由于需要插入语音套管，充当内部套管，为了让病人发声，空气通道可能变得收缩，从而增加气道阻力。施加适当的呼气末正压(PEEP)和呼吸机自动触发的困难也可能是有问题的。因此,在不调整通气设置的情况下，肺泡通气预计会减少。我们使用Blom®气管造口管的经验揭示了一些问题，并为患者管理提供建议。我们在此报告了在声乐训练期间插入Blom®气管造口管接受机械正压通气的患者的经验。
