Predicting the need for nonstandard tracheostomy tubes in critically ill patients

Vinciya Pandian; Christoph T Hutchinson; Adam J Schiavi; David J Feller-Kopman; Elliott R Haut; Nicole A Parsons; Jessica S Lin; Chad Gorbatkin; Priya G Angamuthu; Christina R Miller; Marek A Mirski; Nasir I Bhatti; Lonny B Yarmus

doi:10.1016/j.jcrc.2016.05.025

Predicting the need for nonstandard tracheostomy tubes in critically ill patients

J Crit Care. 2017 Feb:37:173-178. doi: 10.1016/j.jcrc.2016.05.025. Epub 2016 Jun 4.

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD; Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD. Electronic address: vpandia1@jhmi.edu.
² Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA.
³ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
⁴ Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
⁵ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Surgery, Johns Hopkins University, Baltimore, MD; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
⁶ Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD.

PMID: 27756050
DOI: 10.1016/j.jcrc.2016.05.025

Abstract

Purpose: Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway. We sought to identify predictors of nonstandard tracheostomy tubes.

Materials and methods: In this matched case-control study at an urban, academic, tertiary care medical center, we reviewed 1220 records of patients who received a tracheostomy. Seventy-seven patients received nonstandard tracheostomy tubes (cases), and 154 received standard tracheostomy tubes (controls).

Results: Sex, endotracheal tube size, severity of illness, and computed tomography scan measurement of the distance from the trachea to the skin at the level of the superior aspect of the anterior clavicle were significant predictors of nonstandard tracheostomy tubes. Specifically, trachea-to-skin distance >4.4 cm and endotracheal tube sizes ≥8.0 were associated with nonstandard tracheostomy.

Conclusions: The findings suggest that clinicians should consider using nonstandard tracheostomy tubes as the first choice if the patient is male with an endotracheal tube size ≥8.0 and has a trachea-to-skin distance >4.4 cm on the computed tomography scan.

Keywords: Airway; Imaging; Percutaneous; Predictors; Tracheostomy tube.

Publication types

Evaluation Study

MeSH terms

Case-Control Studies
Critical Care
Critical Illness*
Female
Humans
Intubation, Intratracheal / instrumentation*
Male
Middle Aged
Predictive Value of Tests
Respiratory Insufficiency / diagnostic imaging
Respiratory Insufficiency / therapy*
Tomography, X-Ray Computed
Trachea / diagnostic imaging
Tracheostomy / instrumentation*