title: Predicting the need for nonstandard tracheostomy tubes in critically ill patients.
abstract: Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway. We sought to identify predictors of nonstandard tracheostomy tubes.
  
  
  
  In this matched case-control study at an urban, academic, tertiary care medical center, we reviewed 1220 records of patients who received a tracheostomy. Seventy-seven patients received nonstandard tracheostomy tubes (cases), and 154 received standard tracheostomy tubes (controls).
  
  
  
  Sex, endotracheal tube size, severity of illness, and computed tomography scan measurement of the distance from the trachea to the skin at the level of the superior aspect of the anterior clavicle were significant predictors of nonstandard tracheostomy tubes. Specifically, trachea-to-skin distance >4.4 cm and endotracheal tube sizes ≥8.0 were associated with nonstandard tracheostomy.
  
  
  
  The findings suggest that clinicians should consider using nonstandard tracheostomy tubes as the first choice if the patient is male with an endotracheal tube size ≥8.0 and has a trachea-to-skin distance >4.4 cm on the computed tomography scan.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD; Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD. Electronic address: vpandia1@jhmi.edu.
authors.forename: Vinciya
authors.initials: V
authors.lastname: Pandian
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA.
authors.forename: Christoph T
authors.initials: CT
authors.lastname: Hutchinson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Schiavi
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: David J
authors.initials: DJ
authors.lastname: Feller-Kopman
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Surgery, Johns Hopkins University, Baltimore, MD; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Parsons
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Lin
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Chad
authors.initials: C
authors.lastname: Gorbatkin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Priya G
authors.initials: PG
authors.lastname: Angamuthu
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Miller
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Marek A
authors.initials: MA
authors.lastname: Mirski
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD.
authors.forename: Nasir I
authors.initials: NI
authors.lastname: Bhatti
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Lonny B
authors.initials: LB
authors.lastname: Yarmus
mesh_terms: D016022:Case-Control Studies; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000000981:diagnostic imaging; D014139:Tracheostomy / Q000295:instrumentation*
keywords: Airway; Imaging; Percutaneous; Predictors; Tracheostomy tube