What is the appropriate action if a patient with an 8.0-mm fenestrated tracheostomy tube has a cuff pressure of 18 mm Hg while breathing spontaneously?

When a patient has a cuff pressure of 18 mm Hg while breathing spontaneously through a fenestrated tracheostomy tube, the appropriate action is to remove all air from the cuff. The primary purpose of the cuff in a tracheostomy tube is to prevent aspiration and maintain ventilation by creating a sealed airway. However, excessive cuff pressure can compromise blood flow and cause tissue ischemia in the tracheal wall, potentially leading to tracheal injury or necrosis.

In the context of managing cuff pressure, it is critical to maintain it at a safe level, typically below 20 mm Hg to reduce risks associated with high cuff pressures. If the patient is breathing spontaneously, and if the cuff pressure is at or above this threshold, the best practice is to deflate the cuff entirely, as it allows for normal airflow, reduces pressure on the trachea, and may help maintain patient comfort while still providing effective ventilation when necessary.

The other strategies listed involve modifying or managing cuff pressures, but they do not effectively address the high cuff pressure in this scenario. Performing the minimal leak technique or minimum seal technique may help in certain situations but are not indicated when a cuff pressure is already elevated. Adding air to the cuff is counterproductive; it