Respir Care. 2012 Jul 10.
Presence of a tracheostomy tube often decreases the patient’s ability to communicate and to tolerate oral intake. The initial tracheostomy tube change is often recommended between day 7 and 14 post insertion. Local guidelines permit tracheostomy change 5 days after insertion.
We hypothesized that changing tracheostomy tubes before day 7 is associated with earlier use of a speaking valve as well as earlier oral intake compared to changing tracheostomy tubes after 7 days.
We prospectively enrolled 130 admitted patients, after tracheostomy placement to a respiratory care unit between July 2008 and May 2010. Patient data were recorded from the electronic medical record. Primary endpoint was the time from tracheostomy placement to tolerate speaking valve. Secondary endpoint was the time from tracheostomy placement to tolerate oral intake. Complications of tracheostomy change were recorded.
38 patients had the first tracheostomy tube change before 7 day (early group) and 92 patients had the first tracheostomy tube change after 7 days (late group). The early group tolerated a speaking valve significantly sooner than the late group (7 days versus 12 days, P= .001). The early group also tolerated oral intake significantly sooner (10 days versus 20 days, P = .04). After change of the tracheostomy tube, the time to tolerate oral feeding was 5.5 days in both groups. There was no significant difference in time to decannulation between both groups. The early group had a shorter respiratory care unit length of stay (11 d versus 17 d, P = .001), and a shorter hospital length of stay (P= .048), than the late group. There was no difference in survival. There were no complications associated with tracheostomy change.
Tracheostomy change before day 7 is associated with earlier ability to tolerate speaking valve and oral intake. In this series, early tracheostomy change was not associated with increased rate of complications.