A new tracheostomy tube. III. Bronchofiberoptic examination of the trachea after prolonged intubation with the NL tracheostomy tube.

Recent publications show that severe damage to the trachea is still a problem with high-volume, low-pressure cuffs. The NL tracheostomy tube was used in 86 patients for 3 days to 2 months (mean 16 days). This tube has a high-volume, low-pressure cuff with automatic regulation of the cuff pressure at 3 kPa. The tube has a flexible tip. Fiberoptic examination at extubation showed minimal damage to the tracheal mucosa: 33 patients had normal mucosa and the rest had hyperaemia and/or fibrin formation. Four patients had ulcerations from suction catheters and four patients had small, superficial ulcerations produced by the tip of the tube. Of these last four patients, three had skin flaps that exerted pressure on the tube. Severe tracheal damage was prevented due to the combination of automatic regulation of cuff pressure and a flexible tip of the tube.