Originally published on November 30, 2011
There is very little research regarding when it is safe to do the first tracheostomy tube change. Commonly, the first tube change is done between post-op day 7-14. A study was just published in Critical Care Medicine and showed that it is safe to do the first tracheostomy change prior to post-op day 7.
The authors at Mass General in Boston enrolled 130 patients after a tracheostomy placement. Thirty-eight patients received a trach change prior to Day 7 (early group) and 92 patients received a trach change after Day 7 (late group). They found that the early group was more likely to be liberated from the ventilator on Day 7 (100% vs. 45%, p=0.0001), tolerate speaking valve earlier (7 vs. 12 days, p=0.001), more likely to tolerate earlier oral feeding (10 vs. 20 days, p=0.04), and had shorter length of stay (11 vs. 17 days, p=0.001). There was no difference in mortality and no complications associated with the trach change.
Source: Abstract: Fisher et al., (2011). Early tracheostomy change is associated with earlier use of speaking valve and earlier oral intake, Crit Care Med, 39(12), 515.