This study compared the leakage characteristics of different types of dual-cannula fenestrated tracheostomy tubes during positive\npressure ventilation. Fenestrated Portex Blue Line Ultra, TRACOE twist, or R�¨usch Traceofix tracheostomy tubes equipped\nwith nonfenestrated inner cannulaswere tested in a tracheostomy-lung simulator. Transfenestration pressures and transfenestration\nleakage rates were measured during positive pressure ventilation. The impact of different ventilation modes, airway pressures,\ntemperatures, and simulated static lung compliance settings on leakage characteristics was assessed. We observed substantial\ndifferences in transfenestration pressures and transfenestration leakage rates. The leakage rates of the best performing tubes were\n<3.5% of the delivered minute volume. At body temperature, the leakage rates of these tracheostomy tubes were <1%. The tracheal\ntube design was themain factor that determined the leakage characteristics. Careful tracheostomy tube selection permits the use of\nfenestrated tracheostomy tubes in patients receiving positive pressure ventilation immediately after stoma formation and minimises\nthe risk of complications caused by transfenestration gas leakage, for example, subcutaneous emphysema
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