1059

Abstract

Introduction: The percutaneous tracheostomy technique has led to a tend of earlier and more frequent tracheostomies to be performed. However, unplanned tracheostomy decannulations are more frequent and dangerous than ETT-related accidents. Various techniques have been looked at such as adjustable length tracheostomy tubes to help prevent unplanned decannulation. Tracheostomy tubes are usually sutured to the skin. Hypothesis: Suturing the tracheostomy to the skin may paridoxically increase the likely hood for unplanned decannulation. We believe that as the neck moves, the skin pulls away from the underlying trachea, and may displace the tip of the tracheostomy tube out of the airway. Methods: COOK Blue Rhino Percutaneous Tracheostomy kits were used to place #6 and #8 Shiley tracheostomy tubes in 57 patients from July 2011 to August 2012. The tracheostomy tubes were not sutured to the skin, but instead secured only with a velcro tracheostomy tie. Non-inferiority study using a delta value of 20 was performed. Results: In the 13-month period, 57 percutaneous tracheostomies were performed using only tracheostomy ties and no suturing. 2 (3.5%) unplanned tracheal decannulations were noted. This rate was compared to an earlier published standard value of 12.7% for tracheostomies that usually suture the tube to the skin. Our data showed statistical non-inferiority with a delta value of 20 and CI of 95%. Conclusions: Securing tracheostomy tubes with only a tracheostomy tie did not show an increased rate of unplanned tracheal decannulation compare to standard rates where the tube is sutured to the skin. Infact, the opposite may be true, and that suturing the tracheostomy tube to the skin may actually lead to a higher rate of unplanned tracheal decannulations.