{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:35Z","timestamp":1781157695639,"version":"3.54.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Guidelines do not recommend cuffless tracheostomy tubes in patients at risk of aspiration, although there is no evidence supporting the protective effect of cuffed tubes against aspiration or pneumonia. The Zihlschlacht Neurological Rehabilitation Clinic has routinely implemented early transition to cuffless tubes to support rehabilitation, facilitate communication and improve quality of life. This study evaluates the impact of this approach on tracheostomy management and pneumonia rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis included 124 non-ventilated, tracheostomized neurological patients admitted between January 2019 and December 2022. Outcomes were pneumonia, aspiration, secretion burden, and tolerance of speaking valves or decannulation caps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 124 patients, 119 were admitted with cuffed tubes. Pneumonia was documented in 112 patients and aspiration in 77. All patients were switched to cuffless tubes within seven days, including those with severe aspiration. After conversion to cuffless tubes, suspected aspiration decreased from 29 to 13 and confirmed aspiration from 48 to 42 cases, totaling 55, while pneumonia fell to 14. Most patients tolerated speaking valves or decannulation caps immediately, required less suctioning, and showed a marked reduction in secretions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Early conversion to cuffless tubes did not increase aspiration pneumonia and was associated with improved secretion management and easier airway care. These findings challenge the presumed protective role of cuffed tubes and support the feasibility of early cuffless use in neurological rehabilitation. Aspiration risk alone should not preclude early cuffless management. Prospective studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2026.1737737","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:48:58Z","timestamp":1781156938000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking tracheostomy care: cuffless tubes for patients with aspiration"],"prefix":"10.3389","volume":"7","author":[{"given":"Bettina","family":"Arca-Tschudi","sequence":"first","affiliation":[{"name":"VITREA Rehabilitation Clinic","place":["Zihlschlacht, Switzerland"]},{"name":"Private University in the Principality of Liechtenstein (UFL)","place":["Triesen, Liechtenstein"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig D.","family":"Schelosky","sequence":"additional","affiliation":[{"name":"Klinische Neurologie, District Hospital Rohrbach","place":["Rohrbach, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Diesener","sequence":"additional","affiliation":[{"name":"VITREA Rehabilitation Clinic","place":["Zihlschlacht, Switzerland"]},{"name":"Department for Neurological Rehabilitation, Hegau-Jugendwerk","place":["Gailingen, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Politz Geleva","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Neurologie, Cantonal Hospital of M\u00fcnsterlingen","place":["M\u00fcnsterlingen, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Krakow","sequence":"additional","affiliation":[{"name":"VITREA Rehabilitation Clinic","place":["Zihlschlacht, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","article-title":"Dysphagia after stroke: incidence, diagnosis, and pulmonary complications","volume":"36","author":"Martino","year":"2005","journal-title":"Stroke"},{"key":"B2","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.01.009","article-title":"Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit","volume":"18","author":"Falsetti","year":"2009","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1177\/000348949610500401","article-title":"Subglottic air pressure: a key component of swallowing efficiency","volume":"105","author":"Eibling","year":"1996","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e141","DOI":"10.1097\/CCM.0000000000004098","article-title":"Investigating swallowing and tracheostomy following critical illness: a scoping review","volume":"48","author":"Skoretz","year":"2020","journal-title":"Crit Care Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2638","DOI":"10.1161\/STROKEAHA.117.017794","article-title":"Use and timing of tracheostomy after severe stroke","volume":"48","author":"B\u00f6sel","year":"2017","journal-title":"Stroke"},{"key":"B6","volume-title":"Prolongierte Beatmungsentw\u00f6hnung in der Neurologisch-neurochirurgischen Fr\u00fchrehabilitation","author":"Schmidt-Wilcke","year":"2025"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1111\/1460-6984.13029","article-title":"Dysphagia therapy in adults with a tracheostomy: a scoping review protocol","volume":"59","author":"Kadri","year":"2024","journal-title":"Int J Lang Commun Disord"},{"key":"B8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s00063-014-0397-5","article-title":"Oralisierung langzeitbeatmeter patienten mit trachealkan\u00fcle\u2014untersch\u00e4tzte gefahr von dysphagien","volume":"110","author":"Heidler","year":"2015","journal-title":"Med Klin Intensivmed Notfmed"},{"key":"B9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1007\/s00455-006-9047-2","article-title":"Leakage of fluid in different types of tracheal tubes","volume":"21","author":"Winklmaier","year":"2006","journal-title":"Dysphagia"},{"key":"B10","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1007\/s00455-003-0022-x","article-title":"Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology","volume":"18","author":"Suiter","year":"2003","journal-title":"Dysphagia"},{"key":"B11","doi-asserted-by":"publisher","first-page":"402","DOI":"10.5535\/arm.19210","article-title":"What is the adequate cuff volume for tracheostomy tube? 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