Plea for routine endoscopic tracheostomy tube adjustment.

Area of Science:

• Intensive care medicine
• Otolaryngology
• Pulmonology

Background:

• Tracheostomy tube selection is critical for proper tracheal placement.
• Accurate tracheostomy tube placement is essential for managing dysphagia and decannulation.
• Current literature lacks data on the accuracy of tracheostomy tube placement.

Purpose of the Study:

• To investigate the accuracy of tracheostomy tube placement in patients at an early neurological rehabilitation center.
• To analyze the frequency and extent of injuries caused by suboptimal tracheostomy tube placement.
• To identify factors associated with tracheostomy tube malposition.

Main Methods:

• Retrospective single-center analysis of patients with tracheostomy tubes (12/2022-01/2024).
• Routine endoscopic control (tracheoscopy) of tube placement upon admission.
• Analysis of clinical characteristics and endoscopic findings (malpositioned vs. well-positioned tubes).
• Logistic regression model to assess associations between tube position quality and patient/procedural factors.

Main Results:

• 65% of examinations revealed malpositioned tracheostomy tubes (214/327).
• 19% of tracheoscopies showed detectable injuries (mucosal lesions, ulcers, bleeding).
• 35% of examinations demonstrated acceptable tube placement (113/327).
• No association found between tube position quality and gender, age, diagnosis, or time to endoscopic control.

Conclusions:

• A high percentage of suboptimal tracheostomy tube positions necessitates improved management strategies.
• Routine endoscopic control of tracheostomy tube placement should be implemented to mitigate risks of complications like tracheal stenosis.
• Optimization of tracheostomy tube supply and selection is suggested based on findings.