To determine the safety and cost-effectiveness of routinely changing chronic tracheostomy tubes every 6 weeks in chronic ventilator-dependent patients.
A group of chronic disease hospital patients with tracheostomy tubes who require longterm mechanical ventilation (>21 days) was prospectively studied over one year. The cause of respiratory failure varied. (neuromuscular disease, chronic obstructive pulmonary disease, post-op respiratory failure, spinal cord injury.) During the one year period, we altered our practice of changing chronic tracheostomy tubes from q 4 weeks to q 6 weeks. We monitored for signs of tracheostomy tube malfunction, the incidents of ventilator-associated pneumonia (VAP) as well as cost savings. Diagnostic criteria of VAP were modified from those established by the ACCP. Not every suspected case of VAP was confirmed radiographically due to extreme baseline radiographic abnormalities in some patients. In those patients, a positive tracheal aspirate, fever, leukocytosis and a change in their ventilatory demands, (i.e. increased FiO2) were considered diagnostic of a new VAP.
During the one year study period in our select population of chronic ventilator dependent patients, there were >250 tracheostomy tube changes. 19 had VAP at a rate of <5%. These were characterized by trach tube cuff leaks (8), pilot balloon malfunction (2), and trach tube occlusion by secretions (2). Additionally, we estimated a savings of > $30,000/year for that patient population.
Changing tracheostomy tubes from q 4 weeks to q 6 weeks resulted in significant cost savings for our institution with no increased risk of VAP and a low rate of trach tube malfunction. We now routinely change all of our chronic tracheostomy tubes every 6 weeks on all of our chronic ventilator-dependent patients.
The incidence of VAP was not affected by extending routine tracheostomy tube changes from every 4 weeks to every 6 weeks.
P.J. Scalise, None.