Improperly positioned tracheostomy tubes appear to be a "common and important" complication in patients being weaned from mechanical ventilation, clinicians report in August issue of the journal Chest.
Dr. Ulrich Schmidt of Massachusetts General Hospital, Boston, and colleagues retrospectively studied 403 consecutive patients with a tracheostomy who had been admitted to an acute care unit "specializing in weaning from mechanical ventilation" over a 42-month period.
"The incidence of tracheostomy tube malposition was 10% in patients admitted to a respiratory acute care unit with prolonged respiratory failure following critical illness," Dr. Schmidt told Reuters Health.
"Patients with a tracheostomy performed by a non-thoracic subspecialty surgeon were at increased risk of experiencing tracheostomy tube malposition," he noted.
Tracheostomy tube malposition was associated with prolonged mechanical ventilation after tracheostomy (median duration 25 days vs 15 days for correctly positioned tracheostomy tubes), but not with increased length of hospital stay or mortality.
This study, Dr. Schmidt said, suggests that when patients do not wean from the ventilator, tracheostomy malposition "could be a contributing factor (and) in 80% of patients a change of the tracheostomy tube will correct the problem."
"It is almost impossible to predict which patients will have the complication," Dr. Schmidt noted. "Therefore, there should be a high level of suspicion when patients demonstrate unanticipated difficulty being liberated from mechanical ventilation following tracheostomy."
Chest 2008;134:288-294.
Reviewed by Ramaz Mitaishvili, MD
