Upsizing tracheostomies: Impacts on respiratory support needs in a vulnerable population

Area of Science:

• Pediatric pulmonology
• Respiratory care
• Medical device research

Background:

• Proper tracheostomy tube placement is vital for pediatric ventilation and preventing complications.
• Limited research exists on the impact of tracheostomy length on ventilation parameters.
• This study investigates changes in fractional inspired oxygen (FiO2) and other respiratory metrics with increasing tracheostomy tube length.

Purpose of the Study:

• To examine the relationship between tracheostomy tube upsizing and changes in FiO2 in pediatric patients.
• To secondarily assess the impact of tracheostomy upsizing on positive end-expiratory pressure (PEEP), albuterol use, and bagging events.
• To provide insights into optimal tracheostomy management for pediatric patients.

Main Methods:

• A retrospective case series review of pediatric patients under 2 years old who underwent tracheostomy upsizing between 2018 and 2022.
• Interrupted time-series segmented linear models were used to analyze changes in FiO2 and PEEP.
• Data included patient demographics, comorbidities, tracheostomy details, and pre- and post-upsize respiratory parameters.

Main Results:

• Out of 118 patients, 71 underwent at least one tracheostomy upsize.
• No significant difference in FiO2 was observed after the first or second upsizes.
• A significant increase in FiO2 was noted after the third upsize, indicating higher respiratory support needs.

Conclusions:

• Tracheostomy upsizing in pediatric patients can lead to increased FiO2 requirements, particularly after the third upsize.
• This suggests a subgroup of patients with escalating respiratory needs.
• Further increases in tracheostomy length beyond a certain point may offer limited benefit for these patients.