Anthropomorphic Measurements for Improved Selection of Tracheostomy Size and Length

Area of Science:

• Medical Imaging
• Anatomy
• Trauma Surgery

Background:

• Proper tracheostomy tube sizing is crucial for preventing complications in ventilated patients.
• Limited guidelines exist for selecting tracheostomy tube length, especially in complex airways.
• Advanced imaging can aid in assessing challenging airway anatomy.

Purpose of the Study:

• To identify anthropometric factors predicting tracheostomy complications in adult trauma patients.
• To evaluate the utility of skin-to-trachea (STT) distance in predicting tracheostomy placement issues.

Main Methods:

• Retrospective review of 87 adult trauma patients undergoing open tracheostomy.
• Inclusion criteria: preoperative chest computed tomography (CT) and postoperative chest X-ray.
• Analysis of STT distance and its correlation with tracheostomy tube placement and complications.

Main Results:

• Average STT distance was 4.0 cm.
• STT > 4 cm was associated with lower odds of tube termination between clavicles (P=0.004).
• Supraclavicular termination depth was significantly more likely with STT > 4 cm (P=0.024).
• 19.5% supraclavicular placements and 25.3% infraclavicular placements were observed.
• 12.6% inadvertent dislodgements occurred.

Conclusions:

• Pre-tracheal soft tissue thickness > 4 cm increases the risk of suboptimal tracheostomy placement and inadequate tube depth.
• Measuring STT on preoperative CT scans may help identify patients requiring careful tracheostomy tube length selection.
• This measurement can aid surgeons in anticipating and mitigating tracheostomy-related complications in trauma patients.