Evaluation of tracheal diameter after surgical tracheostomy

Single cannula versus double cannula tracheostomy tubes in major oral and oropharyngeal resections

OBJECTIVE

To compare the outcomes of two types of tracheostomy tubes used in major head and neck surgery.

METHODS

A retrospective study was conducted of prospectively collected data. The post-operative safety and adequacy of a single cannula tracheostomy tube was compared to a double cannula tracheostomy tube in patients undergoing tracheostomy during major oral and oropharyngeal resections.

RESULTS

Out of 46 patients with the single cannula tube, 7 (15 per cent) experienced significant obstruction warranting immediate tube removal, while another 9 (20 per cent) needed a change of tube or tube re-insertion for continued airway protection. In contrast, out of 50 patients with the double cannula tube, the corresponding numbers were 0 (p = 0.004) and 1 (2 per cent; p = 0.007) respectively.

CONCLUSION

Insertion of a double cannula (instead of a single cannula) tracheostomy tube in the course of major oral and oropharyngeal resections offers better airway protection during the post-operative period.

Peak flow rate during induced cough: a predictor of successful decannulation of a tracheotomy tube in neurosurgical patients

BACKGROUND

An accurate predictor of successful decannulation in neurosurgical patients that indicates the best time for tracheotomy decannulation would minimize the risks of continued cannulation and unsuccessful decannulation.

OBJECTIVE

To determine whether the peak flow rate during induced cough is an appropriate predictor of successful decannulation.

METHODS

A total of 32 neurosurgical patients with a tracheotomy were enrolled. The highest peak expiratory flow rate during 3 induced coughs, the total volume of tracheal secretions collected in 6 hours, and scores on the Glasgow Coma Scale were recorded. Logistic regression analysis was applied to determine the relationship between these variables and successful decannulation (reintubation not required within 72 hours).

RESULTS

Decannulation was attempted in 23 of 32 patients. The remaining 9 patients were considered clinically inappropriate for the procedure. Of the 23 patients decannulated, 2 required reinsertion of the tracheotomy tube. Analysis revealed that peak flow rate during induced cough (odds ratio, 1.12; 95% confidence interval, 1.02-1.23) was independently associated with successful decannulation (accuracy, 75%; sensitivity, 85.7%; specificity, 54.5%). The receiver operating characteristic curve indicated an optimal cutoff point of 29 L/min.

CONCLUSION

Measurement of peak flow rate during induced cough is a simple and reproducible intervention that improves predictability of successful decannulation in patients with tracheotomy.