Predicting the need for nonstandard tracheostomy tubes in critically ill patients

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)173-178
Number of pages6
JournalJournal of Critical Care
Volume37
DOIs
StatePublished - Feb 1 2017

Keywords

  • Airway
  • Imaging
  • Percutaneous
  • Predictors
  • Tracheostomy tube

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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