TY - JOUR
T1 - Predicting the need for nonstandard tracheostomy tubes in critically ill patients
AU - Pandian, Vinciya
AU - Hutchinson, Christoph T.
AU - Schiavi, Adam J.
AU - Feller-Kopman, David J.
AU - Haut, Elliott R.
AU - Parsons, Nicole A.
AU - Lin, Jessica S.
AU - Gorbatkin, Chad
AU - Angamuthu, Priya G.
AU - Miller, Christina R.
AU - Mirski, Marek A.
AU - Bhatti, Nasir I.
AU - Yarmus, Lonny B.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jcrc.2016.05.025
DO - 10.1016/j.jcrc.2016.05.025
M3 - Article
C2 - 27756050
AN - SCOPUS:85006121081
SN - 0883-9441
VL - 37
SP - 173
EP - 178
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -