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In patients requiring bilevel ventilation, it is crucial that the tracheostomy cuff remains fully inflated during the process. This is because the cuff serves to create a seal within the trachea, preventing air from escaping into the upper airway, which ensures that the positive pressure from the bilevel ventilation can effectively reach the lungs. When the cuff is adequately inflated, it facilitates adequate ventilation and oxygenation by ensuring that airflow is directed solely into the lungs rather than leaking out through the mouth or nose.

Additionally, maintaining a fully inflated cuff can help protect the patient from aspiration, as it acts as a barrier against secretions. In bilevel ventilation, where precise airway pressures are necessary for effective treatment, any air leaks compromise the efficacy of the intervention.

While alternative strategies may be considered for different clinical indications, in the context of bilevel ventilation, maintaining the cuff inflation is essential for achieving the desired therapeutic outcomes.