Tracheostomy Outcomes on Trauma Patients

Tracheostomies are performed in trauma patients for multiple purposes. Approaches to the procedure are usually directed by individual expertise and local preferences. Though generally safe, a tracheostomy can cause serious complications. This study aims to identify complications associated with tracheostomies performed at the level I Trauma Center of the Puerto Rico Medical Center (PRMC) to have an advanced foundation to develop and implement guidelines to improve patient outcomes.

A retrospective cross-sectional study.

Level I Trauma Center of the PRMC.

Medical charts of 113 trauma adult patients that underwent tracheostomy at the PRMC from 2018 to 2020 were reviewed. Data collected included patient demographics, surgical approach, initial tracheostomy tube size (ITTS), intubation period, and flexible laryngoscopic findings. Complications occurring during and after tracheostomy were documented. The unadjusted relationship of the independent variables and outcome measures was assessed using χ ² and Fisher's test for categorical variables and the Wilcoxon-Mann-Whitney rank-sum test for continuous ones.

Abnormal airway findings detected on flexible laryngoscopic examination were reported in 30 patients in the open tracheostomy (OT) group and 43 patients in the percutaneous tracheostomy group (p = 0.007). Peristomal granulation tissue was reported in 10 patients with an ITTS 8, while in only 1 patient with an ITTS 6 (p = 0.026).

This study showed several key findings in our cohort. The OT surgical approach was associated with fewer long-term complications when compared to the percutaneous approach. Also, a statistically significant difference in peristomal granulation tissue findings was found between the ITTS, ITTS-6 and ITTS-8, the smaller size being associated with fewer abnormal findings.