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Blocked Tracheostomy Algorithm — FRCA Final MCQ

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ModerateAirway ManagementBlocked Tracheostomy AlgorithmFRCA Final

A 65-year-old man (ASA III) with a tracheostomy is being weaned from ventilation. He is on a T-piece with humidified oxygen 28%. He suddenly becomes agitated with SpO2 dropping to 75%. A suction catheter will not pass beyond the tracheostomy tube. According to the emergency tracheostomy algorithm, after removing the inner cannula (which does not resolve the obstruction), what is the next step?

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Correct answer: A — Deflate the cuff – if this relieves the obstruction continue with cuff deflated

Following the NTSP/DAS/ICS emergency tracheostomy algorithm: after checking breathing circuit connections and removing the inner cannula (first steps), if the tube remains blocked, the next step is to deflate the cuff. If cuff deflation relieves the obstruction (suggesting the tube was malpositioned or the cuff was occluding the lumen against the tracheal wall), oxygenation via the upper airway may now be possible. If this fails, the tracheostomy tube should be removed entirely and primary oxygenation should be attempted from above (oral route) while simultaneously assessing the stoma for patency.

Reference: DAS/ICS/NTSP – 2023 – Emergency tracheostomy management guidelines