Implementation of AIRVO? System for Postoperative Tracheostomy Care in Head and Neck Free Flaps

Objective: Effective postoperative tracheostomy management after free flap surgery is critical but can offer challenges including difficulty with humidification delivery and contraindications toward neck instrumentation. The purpose of this project was to establish a multidisciplinary team and implement the AIRVOT tracheostomy humidification system for those undergoing free flap surgery and determine its effect on respiratory secretions and related events. Methods: A retrospective cohort study of head and neck free flap surgery patients prior to implementation of AIRVOT (Jan 2021-May 2021) and after (August 2021-December 2021) were analyzed with a 2 month (June 2021-July 2021) implementation phase. Main variables analyzed included excessive tracheal secretions, necessity of supplemental oxygen above baseline for a day or greater, respiratory rapid response calls, elevation to intensive care units (ICU), and length of hospital stay. Results: A total of 82 patients (40 pre-AIRVOT and 42 with AIRVOT) met criteria for the study. A significant reduction in excessive tracheal secretions (40% pre-AIRVOT, 11.9% with AIRVOT, P =.01) and necessity of supplemental oxygen above baseline (25% pre-AIRVOT, 7.1% with AIRVOT, P =.04) were observed. No significant difference in hospital length of stay (P =.63) was observed. No respiratory rapid responses or elevation to ICU care were seen in either groups. Conclusion: The AIRVOT system provided an efficient, portable, free of neck instrumentation, and easy to use device that resulted in a reduction in excessive tracheal secretion events and necessity of supplemental oxygenation needs in free flap tracheostomy patients