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Predicting the need for nonstandard tracheostomy tubes in critically ill patients.

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.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Pandian V,Hutchinson CT,Schiavi AJ,Feller-Kopman DJ,Haut ER,Parsons NA,Lin JS,Gorbatkin C,Angamuthu PG,Miller CR,Mirski MA,Bhatti NI,Yarmus LB

doi

10.1016/j.jcrc.2016.05.025

subject

Has Abstract

pub_date

2017-02-01 00:00:00

pages

173-178

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(16)30110-1

journal_volume

37

pub_type

杂志文章

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