key: cord-0870911-0zxyrq4y
authors: Green, A.O.; Chellappah, A.D.; Fan, K.; Stenhouse, P.D.
title: A novel way to determine the size of tracheostomy tubes using CT Thorax or Pulmonary Angiogram scans during the COVID-19 pandemic
date: 2020-08-19
journal: Br J Oral Maxillofac Surg
DOI: 10.1016/j.bjoms.2020.08.070
sha: 7c24bd1a727a6f811263df78406f391a4d2d8ed7
doc_id: 870911
cord_uid: 0zxyrq4y

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51 referrals for surgical tracheostomies. With 9623 (1) admissions to ICUs nationally, there was a shortage of the commonly used TRACOE® twist tracheostomy tubes with inner and outer cannulas and a subglottic suctioning port.

Appropriate sizing and selection of tracheostomy tubes in the Intensive Care population is essential, with patients remaining intubated for prolonged periods. Correct sizing, for which there are no recognised guidelines, minimises the likelihood of potential complications such as inadequate ventilation, dislodgement, cuff leaks and bleeding.

Selection is based upon gender, body habitus, existing endotracheal tube size and a desire for the end of the tube to be 2-3 centimetres from the carina (2,3).

The majority of patients admitted underwent CT Thorax or Pulmonary Angiogram scans during their diagnostic evaluation or to assess disease progression. As the number of admissions to ICUs and tracheostomy referrals increased and the national shortage of tracheostomy tubes worsened, it was essential we optimised scarce resources.

We considered whether these CT scans could be used to guide selection of tracheostomy tubes and conserve supplies, minimise operative time and reduce physiological stress to the patient associated with multiple tracheostomy changes.

For 11 patients of the 51 who were referred to us for tracheostomies, we used our institution's radiological imaging software (SECTRA) to pre-operatively select the appropriate size tracheostomy tube.

Using multiplanar reconstruction, we measured the distance in millimetres on sagittal views ( Figure   1 ) from:

1) The skin to the anterior tracheal wall at a level 50% of the distance from the inferior thyroid cartilage to the superior aspect of the manubrium of sternum.

2) The anterior tracheal wall to the posterior tracheal wall at a 45º angle.

3) The posterior tracheal wall to a point 30mm above the level of the carina.

We compared these measurements with the size of various TRACOE® twist tracheostomy tubes in order to select the appropriate tube ( Figure 2 ). Only 2 patients (18.2%) required tube changes intraoperatively after videobronchoscopy. One patient due to a short tracheostomy tube and the other patient due to the tracheostomy tube being too long.

This was predicted pre-operatively using the patient's CT Thorax scan, however there were no appropriate size tracheostomy tubes available within the hospital.

The results of our initial prospective study indicate that this technique led to more efficient use of scarce resources and no returns to theatre. We advocate that when a CT Thorax or Pulmonary Angiogram scan is available, it is used preoperatively to select the appropriate size tracheostomy tube. 

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