Anthropomorphic Measurements for Improved Selection of Tracheostomy Size and Length

BackgroundAn appropriately sized tracheostomy is essential to minimizing risk for complications in critically ill patients requiring prolonged ventilator support; however, there are a few recognized guidelines to assist surgeons in selecting appropriate tracheostomy tube length. Advanced imaging studies can be beneficial in evaluating patients with challenging airway anatomy. We aim to determine anthropomorphic factors that can assist in identifying patients who are at increased risk for tracheostomy complications in the adult trauma population.MethodsWe performed a retrospective review of trauma patients who received an open tracheostomy at a level-1 trauma center from August 2021 through March 2023. Criteria for inclusion were a preoperative computed tomography scan of the chest and postoperative chest x-ray. Eighty-seven patients met these criteria.ResultsThere were 17 (19.5%) supraclavicular placements, 22 (25.3%) infraclavicular placements (of which 5 (5.7%) were right mainstem intubations requiring immediate surgical revision, and 11 inadvertent dislodgements (12.6%). The overall average skin-to-trachea (STT) distance was 4.0 cm. Patients with STT >4 cm had 0.280 [0.115-0.680] times lower odds of ETT termination between the clavicles (P = 0.004). Patients with supraclavicular termination depth were 3.667 times more likely to have STT >4 cm (P = 0.024). Infraclavicular placement did not achieve statistical significance for STT >4 cm (P = 0.061).DiscussionPatients with pre-tracheal soft tissue >4 cm have greater odds of suboptimal tracheostomy placement and inadequate tracheostomy tube termination depth. Measuring STT on preoperative neck/chest computed tomography (CT) may be useful in identifying adult trauma patients who will present additional challenges in determining the appropriate tracheostomy tube length.