{"id":1425,"date":"2018-03-20T22:44:05","date_gmt":"2018-03-20T22:44:05","guid":{"rendered":"http:\/\/localhost:8080\/mywordpress\/misconception-cuff-aspiration\/"},"modified":"2020-09-18T14:56:41","modified_gmt":"2020-09-18T21:56:41","slug":"cuff_aspiration","status":"publish","type":"page","link":"http:\/\/142.11.238.239\/es\/cuff_aspiration\/","title":{"rendered":"Misconception: Cuff Deflation"},"content":{"rendered":"<div class=\"l3-header-con no-banner\">\n<div class=\"l3-header-icon\">\n\t\t<img decoding=\"async\"  src=\"\/wp-content\/uploads\/2018\/12\/Trach-Tube-Icon.jpg\" alt=\"keys\" \/>\n\t<\/div>\n<div class=\"l3-header-text no-banner\">\nDesinflado del manguito                         <\/div>\n<\/p><\/div>\n<div style=\"clear:both\"><\/div>\n\r\n<ul class=\"breadcrumb\">\r\n\t<li class=\"active\">Claves Del \u00c9xito<\/li>\r\n\t<li class=\"dropdown\">\r\n\t\t<a href=\"#\" class=\"dropdown-toggle\" data-toggle=\"dropdown\">See All Articles <b class=\"caret\"><\/b><\/a>\r\n\t\t<ul class=\"dropdown-menu\">\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/cuff_aspiration\/\">Desinflado del manguito<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/secretions\/\">Manejo de la Secreciones<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/size\/\">Tama\u00f1o del tubo de traqueostom\u00eda<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/vent_weaning\/\">Ventilaci\u00f3n mec\u00e1nica<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/vent_adjust\/\">Alarmas de Ventilaci\u00f3n mec\u00e1nica<\/a><\/li>\r\n\r\n\t\t<\/ul>\r\n\t<\/li>\r\n<\/ul>\r\n\n<h2 class=\"seminars_header\">Concepto err\u00f3neo: \"No podemos desinflar el manguito\nporque el paciente aspirar\u00e1\"<\/h2>\n<p class=\"page_paragraph\">Los m\u00e9dicos a menudo tienen una idea err\u00f3nea de que el\nmanguito de traqueostom\u00eda impide la aspiraci\u00f3n. Sin\nembargo, la evidencia indica que:<\/p>\n<ul>\n<li>\n<p class=\"page_paragraph\">La aspiraci\u00f3n se produce a nivel de las cuerdas vocales.\nPor lo tanto, cualquier material que llegue al manguito de\ntraqueostom\u00eda ya ha sido aspirado.<\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\">El manguito puede crear un reservorio para las\nsecreciones aspiradas y agrupadas para colonizar.<\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\">Los manguitos no forman un sellado completo contra la\npared traqueal, por lo que el material puede filtrarse\nalrededor del manguito y hacia la v\u00eda a\u00e9rea inferior.<\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\">Hasta el 87% de los pacientes ventilados mec\u00e1nicamente aspiran con los manguitos inflados y el 77% de esas aspiraciones son silenciosas.<sup>1<\/sup><\/p>\n<\/li>\n<\/ul>\n<h2 class=\"seminars_header translation-block\">Investigaci\u00f3n cl\u00ednica que apoya el desinflado del manguito\ny la aplicaci\u00f3n de la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span><\/h2>\n<ul>\n<li>\n<p class=\"page_paragraph translation-block\"><strong>Hay m\u00e1s casos de aspiraci\u00f3n en pacientes con el manguito inflado que con el manguito desinflado.<\/strong> Se ha demostrado que la tasa de aspiraci\u00f3n es 2.7 veces mayor en condiciones de manguito inflado frente al manguito desinflado en el mismo paciente.<sup>2<\/sup> Se ha demostrado que las tasas de aspiraci\u00f3n silenciosa son 22.6% con el manguito inflado en comparaci\u00f3n con 7.2% para condiciones desinfladas.<sup>3<\/sup><\/li>\n<li>\n<p class=\"page_paragraph\"><strong>Hay tasas m\u00e1s altas de infecciones respiratorias con el\ninflado del manguito.<\/strong> En un estudio controlado aleatorizado de pacientes cr\u00edticos, el grupo con manguito inflado tuvo significativamente m\u00e1s infecciones respiratorias, incluida la neumon\u00eda asociada con ventilador, con tasas de 36% versus 20% con los manguitos desinflados.<sup>4<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\"><strong>La fisiolog\u00eda de la degluci\u00f3n es deteriorada con un\nmanguito inflado.<\/strong> Hay una reducci\u00f3n de la elevaci\u00f3n\nlar\u00edngea con el manguito inflado versus el manguito\ndesinflado.<sup>3<\/sup> El reflejo de degluci\u00f3n es cada vez m\u00e1s dif\u00edcil\nde obtener y la latencia de la degluci\u00f3n aumenta con las\npresiones m\u00e1s altas del manguito.<sup>5<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\"><strong class=\"translation-block\">El uso de una V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup> mejora la degluci\u00f3n y\nreduce la aspiraci\u00f3n con mayor frecuencia y de manera\nm\u00e1s significativa que con el desinflado del manguito\nsolo.<\/strong><sup>1,6-8<\/sup><span class=\"translation-block\">Las presiones subgl\u00f3ticas son constantemente cero cuando el tubo est\u00e1 abierto a la presi\u00f3n atmosf\u00e9rica.<sup>9,10<\/sup> Con la V\u00e1lvula, hay un restablecimiento de la presi\u00f3n subgl\u00f3tica en un promedio de 8-10cm H<sub>2<\/sub>O. La V\u00e1lvula tambi\u00e9n facilita el volumen espiratorio a trav\u00e9s de la v\u00eda a\u00e9rea superior despu\u00e9s de la degluci\u00f3n, lo que ayuda a expulsar l\u00edquidos o part\u00edculas de alimentos que pueden desviarse a trav\u00e9s de la tr\u00e1quea durante la degluci\u00f3n.<\/span><sup>11<\/sup><\/li>\n<\/p>\n<\/ul>\n<hr>\n<h2>Videos Relacionados<\/h2>\n<div class=\"row\">\n<div class=\"col-sm-6\">\n<div style=\"max-width: 600px; margin-left: auto; margin-right: auto;\">\n<div class=\"codegena\"><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/MKjlhyQjcwg?rel=0\" width=\"320\" height=\"215\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<p><center><strong><span style=\"font-size: large;\"><\/span><\/strong><\/center><\/div>\n<div class=\"col-sm-6\">\n<div style=\"max-width: 600px; margin-left: auto; margin-right: auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/iyczrjLlmgo?rel=0\" width=\"320\" height=\"215\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<p><center><strong><span style=\"font-size: large;\"><\/span><\/strong><\/center><\/div>\n<div class=\"col-sm-6\">\n<div style=\"max-width: 600px; margin-left: auto; margin-right: auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/lz21bjtamwU?rel=0\" width=\"320\" height=\"215\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<p><center><strong><span style=\"font-size: large;\"><\/span><\/strong><\/center><\/div>\n<div class=\"col-sm-6\">\n<div style=\"max-width: 600px; margin-left: auto; margin-right: auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/bYjLNYob6rs?rel=0\" width=\"320\" height=\"215\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<p><center><strong><span style=\"font-size: large;\"><\/span><\/strong><\/center><\/div>\n<\/div>\n<hr>\n<h3 class=\"benefits\">Fuentes:<\/h3>\n<ol>\n<li>Elpern, E., et al. (1994). Pulmonary Aspiration in Mechanically Ventilated Patients with Tracheostomies. Chest, 105:583-586.<\/li>\n<li>Davis, et al. (2002) Swallowing with a Tracheotomy Tube in Place: Does Cuff Inflation Matter? Journal of Intensive Care Medicine.17(3): 132-135.<\/li>\n<li>Ding, R. &amp; Logeman, J. (2005). Swallow Physiology in Patients with Trach Cuff Inflated or Deflated: A Retrospective Study. Head &amp; Neck. Sep;27(9):809-13<\/li>\n<li>Hernandez, G. et al. (2013). The effects of increasing effective airway diameter on weaning from mechanical ventilation tracheostomized patients: a randomized controlled trial. Intensive Care Medicine. Jun;39(6):1063-70<\/li>\n<li>Amathieu, R. et al. (2012). Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. British Journal of Anaesthesia. Oct;109(4):578-83.<\/li>\n<li>Suiter, D. et. al. (2003). Effects of Cuff Deflation and One Way Speaking Valve Placement on Swallow Physiology. Dysphagia, 18: 284-292.<\/li>\n<li>Stachler, R. et al. (1996). Scintigraphic Quantification of Aspiration Reduction with the <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup> Valve. The Laryngoscope. 106(2): 231-234.<\/li>\n<li>Dettelbach, M., et al. (1995). Effect of the <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup> Valve on Aspiration in Patients with Tracheostomy. Head &amp; Neck, 297-300.<\/li>\n<li>Gross, R., et al. (2003). Direct measurement of subglottic air pressure while swallowing. The Laryngoscope, 116: 753-760.<\/li>\n<li>Eibling, D. &amp; Gross, R. (1996). Subglottic air pressure: a key component of swallowing efficiency. Annals of Otology, Rhinology &amp; Laryngology, 105 (4):253-258.<\/li>\n<li>Prigent, H., et al. (2011). Effect of a tracheostomy speaking valve on breathing\u2013swallowing interaction. Intensive Care Medicine. Published online: 24 November 2011.<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"Cuff Deflation Misconception: &#8220;We can&#8217;t deflate the cuff because the patient will aspirate&#8221; Clinicians often have a misconception that the tracheostomy cuff prevents aspiration. However, evidence indicates that: Aspiration occurs at the level of the vocal folds. Therefore, any material that reaches the tracheostomy cuff has already been aspirated. The cuff may create a reservoir [&hellip;]","protected":false},"author":6,"featured_media":5491,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yst_prominent_words":[83,735,734,306,726,731,736,724,730,728,727,82,75,72,74,73,733,725,729,732],"_links":{"self":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1425"}],"collection":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/comments?post=1425"}],"version-history":[{"count":6,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1425\/revisions"}],"predecessor-version":[{"id":15331,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1425\/revisions\/15331"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/media\/5491"}],"wp:attachment":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/media?parent=1425"}],"wp:term":[{"taxonomy":"yst_prominent_words","embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/yst_prominent_words?post=1425"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}