Question: With regards to the CPAP protocol, one contraindication is a tracheostomy. If this was just temporary and the tube had recently been removed, would CPAP be able to be administered?

 Excellent question! You are correct, a tracheostomy is an absolute contraindication to the use of CPAP. The obvious concern would be that it would be impossible to maintain a pressure gradient in the lower airways if all of the oxygen is escaping out of the tracheostomy.

If the tube has been recently removed as you suggest, however the stoma (the hole) remains patent, then this contraindication remains. It is imperative for the stoma to be fully healed, closed, and ideally not just within recent weeks of closing over as the concern would be that a "fresh" tracheostomy wound may reopen given the pressure from CPAP. Given the variability of wound closure, it is impossible to list a firm date as to when the wound can be considered "healed".

Bottom line: If a tracheostomy wound is still patent, or if the paramedic has concern that the tracheostomy wound is freshly closed over from a recent tube removal, it is best to use alternative means at supporting respirations other than CPAP.

Airway/Breathing,Continuous Positive Airway Pressure (CPAP)

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