S. J. Clark1, J. M. Klugh1, E. A. Taub1, C. E. Wade1, J. A. Harvin1 1University Of Texas Health Science Center At Houston, Surgery, Houston, TX, USA
Introduction: Tracheostomy tube placement is a common procedure performed when patients need long term definitive airway management. Historically, a size 8.0 tube is placed initially, but placing a size 6.0 has theoretical benefits of a shorter delay to taking food by mouth and a faster time to decannulation. We hypothesize there will be no difference in complication rates between initial placement of a size 6.0 versus a size 8.0.
Methods: Adult trauma tracheostomy patients between 1/1/2019 and 12/31/2021 were included. Laryngeal trauma, emergency airway, and burn patients were excluded. Patients were dichotomized into two groups based on whether they initially received a size 8.0 or 6.0 Shiley tube at the initial operation. The primary outcome was complication rates. Secondary outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, and days to decannulation and oral intake.
Results: 431 patients met study criteria, with 358 having received a size 8.0 initially and 73 received a size 6.0. There was no difference between age, mechanism of injury, injury severity score, or indication for tracheostomy. Size 8.0 patients were more likely to be male (83% vs 63%, p<0.001) and to undergo percutaneous tracheostomy (63% vs 33%, p<0.001). There was no difference in mortality, subglottic stenosis, or bleeding that required the operating room between groups. Size 8.0 were less likely to require upsizing (0% vs 4%, p=0.016). The size 6.0 group had a shorter hospital LOS, ICU LOS, and ventilator days (Table). No difference was seen in days to decannulation or oral intake (Table). The size 8.0 group was more likely to be decannulated prior to discharge (24% vs 12%, p=0.028), though this was confounded by a longer hospital LOS.
Conclusion: Other than the rare upsizing, there was no difference in complications between the size 6.0 and 8.0 groups. The size 6.0 group had a shorter hospital and ICU LOS and fewer days on the ventilator. Granular outpatient data is needed to accurately assess the effect tube size has on time to decannulation and first PO intake as the size 6.0 group was discharged sooner. Overall, initial size 6.0 placement is a safe and viable alternative to size 8.0 placement that can reduce LOS.
