TY - JOUR
T1 - Are fenestrated tracheostomy tubes still valuable?
AU - Pandian, Vinciya
AU - Boisen, Sarah E.
AU - Mathews, Shifali
AU - Cole, Therese
N1 - Funding Information:
This is an investigator-initiated grant funded by Medtronic, awarded to Johns Hopkins School of Nursing. Medtronic had no role in project design or execution. Medtronic approved this submission without any modification to manuscript content. Pan-dian has received two research grants from the National Institutes of Health (NIH). She is funded through the NIH/National Institute of Nursing Research to assess symptoms and screen for laryngeal injury postextubation in intensive care unit settings (Grant R01NR017433-01A1). She is also funded through NIH/ National Institute of Aging to evaluate the effectiveness of a novel arm restraint for intubated patients with cognitive impairment to reduce agitation, sedation, and immobility (Grant R42AG059451). We thank Martin Blair, Editor, for providing editorial support.
PY - 2019/8
Y1 - 2019/8
N2 - Purpose: The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method: A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results: Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions: Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.
AB - Purpose: The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method: A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results: Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions: Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.
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U2 - 10.1044/2019_AJSLP-18-0187
DO - 10.1044/2019_AJSLP-18-0187
M3 - Article
C2 - 31318610
AN - SCOPUS:85071346364
VL - 28
SP - 1019
EP - 1028
JO - American Journal of Speech-Language Pathology
JF - American Journal of Speech-Language Pathology
SN - 1058-0360
IS - 3
ER -