Tracheostomy is common in chronically ventilated patients. Many of these patients can be weaned. Two types of tracheostomy tubes, fenestrated (F) and non-fenestrated (NF), are available. With fenestrated tube use the granulation tissue tends to grow through the holes. It causes multiple complications imposing delay in weaning. Our aim was to review our experience in weaning with fenestrated versus non-fenestrated tubes.
We retrospectively reviewed tracheostomy weaning in a 50-bed subacute care unit. Patients had both types of tube. Observations were made based on tracheostomy related complications like granuloma formation, difficulty in changing the tracheostomy tubes for down-sizing and need for surgical intervention. The weaning duration and success rates were recorded.
Medical records of 137 patients were reviewed. A total of 45 patients had fenestrated tubes. Mean weaning duration was 12 (SD 1.5) days. A remaining 89 patients had non-fenestrated tubes with a mean weaning duration of 7 (SD 1.5) days (P=0.00, Pooled t-test). All the patients were decannulated. No significant differences were noted based on diagnosis, age or sex. Surgical intervention was needed in 15.6% (7/45) of patients with fenestrated tubes compared to 14.6% (13/89) with non-fenestrated tubes (P=1.000, Fisher Exact). The significant differences were: Total complications: F= 25/45, NF=14/89 (P=0.000), Granuloma: F=7/45, NF=2/89 (P=0.007), Tracheostomy obstruction: F= 3/45, NF=0/89 (P=0.036), Stuck tracheal tube F=7/45, NF=2/89 (P=0.007). (P’s from two-sided Fisher Exact). Other complication rates including bleeding, subglottic and tracheal stenosis were non-significant.CONCLUSIONS: Non-fenestrated tracheostomy tubes in long-term clinical setting have a significantly shorter weaning duration and a lower complication rate compared to the fenestrated type tubes, which may be better suited in acute and short-term clinical setting.
Non-fenestrated tracheostomy tubes should be used in patients who need long-term tracheal access. It is likely to reduce complication rates and facilitate weaning from tracheostomy.
D.K. Shrivastava, None.