38 RESPIRATORY MANAGEMENT FOLLOWING SPINAL CORD INJURY Appendix E: Cuff Deflation Protocol for Ventilator-Dependent Quadriplegic Patients The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (December 1996). Rationale: To establish guidelines to be followed for cuff deflations for all ventilator protocol patients. D. No clinical evidence of aspiration/laryngeal penetration. IV Schedule for cuff deflations. RCP writes “Cuff . Deflation Protocol” orders. Physician signs off on orders within 24 hours. A. 2 minutes TID 5 minutes TID 10 minutes TID 20 minutes TID 30 minutes TID 60 minutes TID 2 hours TID 3 hours BID 4 hours BID 8–10 hours QD 12 hours QD 14 hours QD 16 hours QD 18 hours QD 20 hours QD 22 hours QD 24 hours QD B. On the judgment of the RCP a patient can , have time increased a maximum of two steps at a time on the cuff deflation protocol schedule. V . Cuff deflations should be done with trach talk during weans as tolerated. Some patients may only be able to tolerate cuff deflations on the ventilator but not during the weans. Scope: Respiratory care practitioners (RCPs) and all other clinicians with demonstrated competencies. Policy Statement: The following criteria will be used for cuff deflations for patients who are participating in the ventilator protocol but may be ordered separately. Procedure: I. Physician writes “Cuff Deflation Protocol” when patient is admitted to hospital. II. Criteria to begin or increase cuff deflations: A. No significant problem with aspiration. B. Patient is already eating without problems. C. Physician and speech therapist clearance note: May use minimal leak technique for those patients unable to swallow, if cleared by pulmonologist and physician. D. Patient agrees to the procedure. E. Chest x-ray is clear or improving. Exceptions: May try cuff deflations if patient has zero vital capacity and will never be weaned from the ventilator, but has minor atelectasis. III. Cuff deflations should be maintained for 1–3 days and may be increased under the following conditions. A. Patient agrees to increase the cuff deflations. B. Chest x-ray is clear or improving. C. ABGs or pulse oximetry is within acceptable limits. VI. Therapist may increase tidal volume with cuff deflations from 100 to 400cc to improve patient tolerance and compensate for the leak. VII. Therapist may increase peak flow with cuff deflations for patient tolerance and compensate for the leak. VIII. All cuff deflations should be documented on wean sheets whether they are completed or not. IX. Cuff deflations may be discontinued or reduced in length of time if patient has either persistent