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Tracheostomy Tube Malposition In Patients Admitted To A Respiratory Acute Care Unit Following Prolonged Ventilation

¹Department of Anesthesia and Critical Care, Massachusetts General Hospital ²Department of Respiratory Care, Massachusetts General Hospital ³Department of Critical Care Medicine, University of Calgary

uschmidt{at}partners.org

Abstract

Background: Tracheostomy tube malposition is a barrier to weaning from mechanical ventilation. We determined the incidence of tracheostomy tube malposition, identified associated risk factors and examined the effect of malposition on clinical outcomes.

Methods: We performed a retrospective study on 403 consecutive patients with a tracheostomy admitted to an acute care unit specializing in weaning from mechanical ventilation between July 1, 2002 and December 31, 2005. Bronchoscopy reports were reviewed for evidence of tracheostomy tube malposition (> 50% occlusion of lumen by tissue). The main outcome parameters were incidence of tracheostomy tube malposition; demographic, clinical and tracheostomy related factors associated with malposition; clinical response to correct the malposition; duration of mechanical ventilation, length of hospital stay, and mortality.

Results: Malpositioned tracheostomy tubes were identified in 40 of 403 patients (10%). Subspecialty of the surgical service who performed the tracheostomy was most strongly associated with malposition. Thoracic and general surgeons were equally likely while other subspecialty surgeons were more likely (odds ratio 6.42, 95% CI; 1.82 –22.68, P=0.004) to have their patients associated with a malpositioned tracheostomy tube. Malpositioned tracheostomy tubes were changed in 80 % of cases. Malposition was associated with prolonged mechanical ventilation post tracheostomy (median, 25 d vs. 15 d, p =0.009), but not with increased hospital length of stay or mortality.

Conclusion: Tracheostomy tube malposition appears to be a common and important complication in patients weaning from mechanical ventilation. Surgical expertise may be an important factor that impacts this complication.

Key Words: Tracheostomy • airway obstruction • weaning • mechanical ventilation • tracheal stenosis