MINI REVIEW article
Front. Rehabil. Sci.
Sec. Rehabilitation in Neurological Conditions
Evidence and Alternatives to the Routine Use of Cuffed Tracheostomy Tubes in Spontaneously Breathing Patients with neurological disorders
Bettina Arca-Tschudi 1,2
Monika Rüegg 3
Paul Diesener 1
Karsten Krakow 1
1. Zihlschlacht Neurological Rehabilitation Clinic, Hauptstrasse 2, 8588 Zihlschlacht, Switzerland, Zihlschlacht, Switzerland
2. Private Universitat im Furstentum Liechtenstein, Triesen, Liechtenstein
3. Logopädie Rüegg, Im Spicher 13, 8471 Bänk bei Winterthur, Bänk bei Winterthur, Switzerland
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Abstract
Introduction: Cuffed Tracheostomy tubes (TT) are often used in spontaneously breathing patients with neurological impairment because of a high risk of aspiration. Besides to the well-known risks, cuffed TT impair cough efficiency and therapeutic strategies for the treatment of dysphagia. Methods: A PRISMA-based systematic review of MEDLINE, PubMed and Cochrane examined the available evidence on cuffed tracheostomy tubes in spontaneously breathing, neurologically impaired adult patients and summarized key findings and alternatives to their routine use. Results: The studies - mostly clinical reports and narrative reviews - describe in-house treatment strategies to minimize tracheal damage caused by cuffed TT. No RCTs were found that prove the benefit of cuffed TT in patients with a high risk of aspiration. Conclusion. The current data does not support the routine use of cuffed TT in non-ventilated patients with neurological impairment and a high risk of aspiration. Prospective studies are required to compare the benefit of cuffed versus cuffless TT in this population to prevent aspiration pneumonia.
Summary
Keywords
aspiration, Cuffed tracheostomy tube, Evidence based tracheostomy tube management, neurological rehabilitation, Non ventilated, spontaneous breathing, tracheostomy tube weaning, tracheotomized
Received
02 November 2025
Accepted
29 January 2026
Copyright
© 2026 Arca-Tschudi, Rüegg, Diesener and Krakow. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Bettina Arca-Tschudi
Disclaimer
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