Oxygen Delivery via Tracheostomy Stoma

Oxygen Delivery Methods for Tracheostomy Patients

In patients with tracheostomy, oxygen is predominantly delivered via a tracheostomy mask, which is a variable performance device capable of delivering oxygen concentrations up to 60-70% 2
If higher oxygen concentrations are required, a T-piece device fitted directly to the tracheostomy tube should be used 4
For patients requiring emergency oxygenation through a stoma, a pediatric facemask or supraglottic airway device applied over the stoma attached to a bag-valve mask can be effective 5

Humidification is essential when delivering oxygen via tracheostomy as the tube bypasses the patient's natural mechanisms to warm and moisturize inspired gases 3
Proper humidification helps maintain a patent tracheostomy tube, reduces secretion buildup, and minimizes patient discomfort 2
Bubble bottles should not be used for humidification as there is no evidence of clinical benefit and they pose an infection risk 2, 4

Inadequate humidification can lead to buildup of secretions within the inner tube or tracheostomy 2
Inadequate humidification can lead to potential tube obstruction 2
Inadequate humidification can lead to patient discomfort 3
When a patient deteriorates and requires increased oxygen concentration exceeding what a variable performance interface can deliver (60-70%), switch to a T-piece device fitted directly to the tracheostomy tube 2, 4
The upper airway may need to be occluded when delivering oxygen via the stoma to prevent air leakage and ensure effective ventilation 5

In emergency situations, if the patient is breathing spontaneously via the tracheostomy tube or open stoma, oxygen should be applied directly to that site 5
If ventilation via the upper airways is not possible or inadequate, ventilation should be attempted via the stoma 6
For rescue breaths in emergency situations, high-flow oxygen should be delivered via the stoma if the upper airway is obstructed 5