Pondering for the frequency of routine single-lumen tracheostomy tube change for ongoing airway management in adult intensive care unit

ABSTRACT

Background: Tube blockage in the Intensive Care Unit (ICU) leads to preventable deaths. Routine change of tube for ongoing airway management is one of the indications for tracheostomy tube (TT) changes. However, there are limited data or evidence to recommend the frequency of such change. Aim: The study aims to determine the frequency of routine TT change in adult ICU patients. Subjects and Methods: A retrospective evaluation of ICU records of the patients who had been on TT for >5 days from July 2013 to April 2015 was performed. Data with regard to age, sex, diagnosis, and on tube days (TDs) before the TT was changed with either confirmed/suspicion of blockage and nonblockage were collected. Patients who had blockage and nonblockage were analyzed as individual groups as well as compared using INSTAT software to find the statistical estimates. Results: A total of 62 patients (72.58% males; mean ± standard deviation age 50.62 ± 18.47 years; mean intubated days of 11.42) with a total of 1022 TT days were evaluated. Fifty-six episodes of tube blockage and 57 episodes (each >5 TT days) of nonblockage were analyzed and compared. The 95% confidence interval (CI) for mean of on TDs for nonblockage and blockage was 7.16–8.27 and 8.08–9.84 days, respectively, in the study population (P = 0.0171). Conclusion: The frequency for routine change of single-lumen TT for ongoing airway management in ICU patient should be 7–10 days taking the lowest 95% CI for nonblockage as the earliest point and the highest 95% CI for blockage as the late point.