(452) Size of Pediatric Tracheostomy Tube and Predictors of Post-operative Complications

Introduction: Pediatric tracheostomy (trach) placement can have life-threatening complications. Age has traditionally been used to guide trach tube size. This study aims to 1) Investigate weight as an alternative guide for trach tube choice and 2) Evaluate complications 3-months post-trach and associations with patient and trach tube factors.

Methods: A retrospective review was performed on patients < 2 years old who underwent a trach from 2017-2022 at a tertiary care children’s hospital. Demographics, trach size/length, chest x-ray (CXR) measurements and complications within 3 months post-trach were collected. Associations between these variables were evaluated using Chi-squared, Fisher’s exact, Wilcoxon rank-sum, and t-tests and Spearman rank correlation.

Results: A total of 68 patients were included. Median age at procedure was 4 months (range 1 day-20 months). Most patients underwent trach for chronic respiratory failure (52/68, 77%). Major complications occurred in 16/68 (24%) patients and were associated with being male (p=0.006) and shorter distance from the distal end of the trach tube to carina on CXR (p=0.03). Distance from the thoracic inlet to carina on CXR was more closely associated with weight (ρ=0.403, p=0.0007) than with age (ρ=0.291, p=0.02). There was no correlation between distance from trach tube to carina measured intraoperatively and on intensive care unit (ICU) CXR (ρ=0.248, p=0.06). There was no association between complications and comorbidities, stoma dressing/maturation, or use of post-operative paralytics.

Conclusions: In this retrospective cohort, CXR calculation was more associated with complications as compared to intraoperative calculations and was more associated with weight rather than age. Though intraoperative scope findings may indicate adequate placement, positional changes once in the ICU may change and CXR findings there may be more indicative of true trach placement. A prospective evaluation of a weight-based algorithm for trach size choice and comparison of intraoperative scope findings and CXR calculations may aid in reducing post-trach complications.