Mechanical Positive Pressure Ventilation and Voice Training via the Blom® Tracheostomy Tube: A Case Study

Patients with a Blom® tracheostomy tube (containing a cuff) can vocalize while on mechanical ventilation, which can significantly improve the patient's quality of life. This is brought by the purpose-built structure of the tracheostomy tube that allows the expiration to be expelled through the glottis. However, this characteristic may complicate the measurement of the patient's tidal volume, as most of the expiration does not return to the ventilator. Owing to the necessity of insertion of the speech cannula, which acts as an inner cannula, to enable patient vocalization, the air passage likely becomes constricted, thus increasing airway resistance. Difficulty in applying appropriate positive end-expiratory pressure (PEEP) and ventilator auto-triggering may also be problematic. Therefore, alveolar ventilation is predicted to decrease without adjusting the ventilation settings. Our experience using the Blom® tracheostomy tube revealed some problems, and we provide suggestions for patient management. We herein report on the experience of a patient having inserted the Blom® tracheostomy tube receiving mechanical positive pressure ventilation during vocal training.