Are Fenestrated Tracheostomy Tubes Still Valuable?

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Abstract

Purpose

The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution.

Method

A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period.

Results

Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution.

The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%).

Conclusions

Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.

Related collections

Most cited references 37

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Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care

Gai Cole, Alexander T. Hillel, Simon R. Best … (2018)

To systematically review the symptoms and types of laryngeal injuries resulting from endotracheal intubation in mechanically ventilated patients in the ICU.

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Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002.

Christopher E Cox, Christopher Carey, Dean Carson … (2004)

Patients who require tracheostomy for prolonged mechanical ventilation have poor outcomes and high costs of care. However, recent longitudinal trends relevant to these patients and their care have not been described. We aimed to describe trends in the annual incidence and timing of tracheostomy for prolonged mechanical ventilation, as well as prolonged mechanical ventilation patient resource utilization and overall in-hospital mortality. Retrospective review of the North Carolina Hospital Discharge Database, a comprehensive record of all state nonfederal, nonpsychiatric hospital discharges between 1993 and 2002. Patients were 9,794 medical and surgical patients >/=18 yrs of age with International Classification of Diseases, Ninth Revision, Clinical Modification code 96.72 (mechanical ventilation for >96 hrs) and Diagnosis Related Group code 483 (tracheostomy except for face, neck, and mouth diagnoses). None. Incidence rates adjusted for annual population growth, mechanical ventilation days until tracheostomy placement, length of stay, and hospital charges and payments adjusted by the medical component of the Consumer Price Index. Between 1993 and 2002, the incidence of tracheostomy for prolonged mechanical ventilation increased across all age groups from 8.3 of 100,000 to 24.2 of 100,000 (p < .001), although most significantly among patients <55 yrs of age. During this period, a decrease was seen in mortality (from 39% to 25%), median mechanical ventilation days to tracheostomy placement (from 12 to 10 days), and median length of stay (from 47 to 33 days). By 2002, patients were almost three times less likely to be discharged to home independently although twice as likely to be sent to a skilled nursing facility. Although prolonged mechanical ventilation patients with tracheostomies represented only 7% of all who required mechanical ventilation, their total charges during the study period were 1.74 billion dollars-22% of all mechanical ventilation patient charges. The incidence of tracheostomy for prolonged mechanical ventilation increased by nearly 200% during the past decade in North Carolina, exceeding changes in the overall incidence of respiratory failure three-fold. Although in-hospital mortality, length of stay, and charges per patient fell over time, the overall resource utilization of prolonged mechanical ventilation patients increased dramatically.

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An overview of complications associated with open and percutaneous tracheostomy procedures

Anthony Cipriano, Melissa L Mao, Heidi Hon … (2015)

Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

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Author and article information

Journal

Journal ID (nlm-ta): Am J Speech Lang Pathol

Journal ID (iso-abbrev): Am J Speech Lang Pathol

Journal ID (publisher-id): AJSLP

Title: American Journal of Speech-Language Pathology

Publisher: American Speech-Language-Hearing Association

ISSN (Print): 1058-0360

ISSN (Electronic): 1558-9110

Publication date (Print): August 2019

Publication date (Electronic): 17 July 2019

Publication date PMC-release: 1 February 2020

Volume: 28

Issue: 3

Pages: 1019-1028

Affiliations

[a ]Johns Hopkins School of Nursing, Baltimore, MD

[b ]The Johns Hopkins Hospital, Baltimore, MD

Author notes

Disclosure: The authors have declared that no competing interests existed at the time of publication.

Correspondence to Vinciya Pandian: vpandia1@ 123456jhu.edu

Editor-in-Chief: Julie Barkmeier-Kraemer

Editor: Nancy Solomon

Article

Publisher ID: 23814764000300140072

DOI: 10.1044/2019_AJSLP-18-0187

PMC ID: 6802915

PubMed ID: 31318610

SO-VID: 63183053-2eda-496c-8237-afed2eb3133b

License:

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

History

Date received : 27 August 2018

Date revision received : 31 January 2019

Date accepted : 29 March 2019

Page count

Pages: 10

Funding

This is an investigator-initiated grant funded by Medtronic, awarded to Johns Hopkins School of Nursing. Medtronic had no role in project design or execution. Medtronic approved this submission without any modification to manuscript content. Pandian has received two research grants from the National Institutes of Health (NIH). She is funded through the NIH/National Institute of Nursing Research to assess symptoms and screen for laryngeal injury postextubation in intensive care unit settings (Grant R01NR017433-01A1). She is also funded through NIH/National Institute of Aging to evaluate the effectiveness of a novel arm restraint for intubated patients with cognitive impairment to reduce agitation, sedation, and immobility (Grant R42AG059451).

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