The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

COMPARISON OF CHANGE DATE OF TRACHEOSTOMYTUBES FOR PERCUTANEOUS VS. OPEN TRACHEOSTOMY IN A RESPIRATORY ACUTE CARE UNIT

Daniel F. Fisher1, Tina Chisholm1, Julie MacPherson-Clements1, Dean Hess1, George Velmahos3, Ulrich Schmidt2,1; 1Respiratory Care Services, Massachusetts General Hospital, Boston, MA; 2Anesthesia & Critical Care, Massachusetts General Hospital, Boston, MA; 3Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, MA

INTRODUCTION: Down sizing of the tracheostomy tube is often performed to allow the patient to tolerate a speaking valve. However tracheostomy change has been associated with a significant morbidity and mortality and tracheostomy tubes changes are recommended after day 10 post insertion. Percutaneous tracheostomy provides earlier maturation of the stoma and therefore tracheostomy changes might be performed safely at an earlier time. We hypothesize change of percutaneously inserted tracheostomy tubes before day 10 is safe and permits earlier use of a speaking valve compared to later changed tracheostomy tubes METHODS: A relational database was developed to track all patient activity that occurred in an acute care unit in a large academic medical center. All airway activity for the period of July 2, 2008 through May 4, 2009 was entered into this system by the respiratory therapists assigned to the unit. Specific information recorded was tracheostomy technique, date of tracheostomy, and event action date. The data was queried for interventions such as tracheostomy tube change, and first use of a speaking valve. Complications of tracheostomy tube change have been predefined as inability to change tracheostomy, loss of airway, desaturation, bleeding and aspiration RESULTS: During the period there were 72 initial tracheostomy changes. Of the 72 patients, 6 were excluded because they had a long-term history (> 1 year) having a tracheostomy. There were no complications noted during tube placement. For initial tracheostomy change 44% (n=29) of the percutaneously inserted were changed < 10 days after insertion, whereas 5 (8%) of the open tracheostomy tubes were changed within this time span (p<0.001). Patients who underwent a tracheostomy change prior to speaking valve 15 (36%) of the percutaneous insertion group and 1 (2%) of the open insertion group had a speaking valve placed within 10 days of the airway change (p<0.05).When all patients who had a speaking valve placed were compared, 20/83 (24%) of the percutaneous group were placed < 10 days and 10/83 (12%) of the open group . Speaking valve placement occurred after 10 days in 29/83 (35%) and 24/83 (29%), patients for percutaneous and open tracheostomy placement respectively (p>0.2). CONCLUSION: Percutaneous inserted tracheostomy tubes are changed earlier than open method of tracheostomy. Tracheostomy change of percutaneous tubes before day 10 was not associated with complications. Sponsored Research - None

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