Capping a cuffed tracheostomy tube

In the article “Promoting Effective Communication for Patients Receiving Mechanical Ventilation” (June 2011:46–61), the authors did a nice job reviewing different communication options, but I need to correct one small but important issue regarding tracheostomies. The authors stated that it is permissible to cap a cuffed tracheostomy with a fully deflated cuff. I must clarify that the only cuffed tracheostomy tube that is safe to cap is one whose cuff lies tight against the shaft of the tube when deflated, essentially disappearing.¹  The Bivona TTS²  and Arcadia CTS³  tubes are the only cuffed tubes that currently have this design. They are low-volume, high-pressure cuffs, in contrast to the usual high-volume, low-pressure cuffs that are inherent to all other cuffed tubes.

Capping forces the patient to breathe completely around the tube and the deflated cuff (if present). The folds of the deflated cuff on standard tracheostomy tubes provide...