Complications and Efficacy of Securing a Percutaneous Dilational Tracheostomy Tube via Collar Fixation Only: A Retrospective Cohort Study

SESSION TITLE: Mechanical Ventilation & Respiratory Failure I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The Ciaglia percutaneous tracheostomy method has been in use since its inception in 1985, and percutaneous approaches to tracheostomies have become increasingly favored over surgical modalities because of risk of maceration, infection, prevention of routine maintenance, and skin irritation. This study investigates the effect of foregoing sutures on post-procedural complications of percutaneous tracheostomies. METHODS: Patients who received tracheostomies by medical and surgical intensivists at RUHSMC between January 2010 and March 2016 were enrolled. All tracheostomies were secured with collar fixation only. Data were collected through retrospective chart review. Baseline patient demographics included age, ethnicity and body mass index (BMI). Primary safety endpoints (complications) included accidental decannulation, surgical site infection rates and bleeding. Secondary endpoints included ICU length of stay and hospital length of stay. Data was collected from time of admission to end of hospitalization. All analyses were performed using SAS program (university edition; SAS Institute Inc., Cary, NC). RESULTS: Among the 241 patients, 58% were male and 61% were white. The mean age was 57±16 years and mean BMI was 28±9 (Kg/m2). The rate of accidental decannulation was 2.1% (95% CI: 0.3-3.9%) and the rate of surgical site infections was 0.4% (95% CI: −0.4-1.2%). Bleeding requiring intervention occurred in 5.0% (95% CI: 2.3-7.8%) of patients. The mean hospital length of stay was 41±32 days. Mean ICU length of stay was 31±19 days. CONCLUSIONS: Collar fixation alone of a percutaneously inserted tracheostomy tube is feasible, with acceptably low rates of accidental decannulation, surgical site infections, and bleeding. CLINICAL IMPLICATIONS: More study is necessary to determine if collar fixation alone of a percutaneously inserted tracheostomy tube is superior to collar fixation with suturing with regard to incidence of complications. DISCLOSURE: The following authors have nothing to disclose: Haik Yanashyan, Alexander Friedman, Shu-Yi Liao, Lynette Ilano, Saeed Afaneh, Maulik Rajyaguru, John Agapian, Ramiz Fargo, Siavash Farshidpanah, Walter Klein No Product/Research Disclosure Information