(1064) The Impact of Head and Neck Position on Tracheostomy Tube Position

Introduction: Tracheostomy tube position in pediatric patients is critical for maintaining adequate ventilation and minimizing risk of displacement into the mainstem bronchus or accidental decannulation. Although previous literature has used several methods to show changes in tracheal length and intubation depth with head and neck positioning in endotracheal intubation, differences in distance in tracheostomies has not been previously quantified. The purpose of this study was to quantify the effect of head and neck position on tracheostomy tube position.

Methods: In this prospective study conducted at a tertiary hospital, we enrolled pediatric patients under 18 years undergoing planned tracheostomy. Post-tracheostomy placement, we used calibrated measurement with tape markings on a flexible fiberoptic endoscope to measure distance in millimeters from tracheostomy tube tip to carina in the operating room. Measurements were collected in five positions: (1) neck extended on the shoulder roll, (2) neutral head/neck, (3) chin to chest, and (4) rotated 45 degrees left and (5) right.

Results: Our initial pilot study included four patients. In neutral head position, the mean tracheostomy tube tip to carina difference was 13.3 (± 1.5) mm. In flexion, mean distance was 15.0 (± 2.5) mm, 1.7 mm greater than in neutral, and in extension mean difference was 9.8 (± 4.4) mm, 3.5 mm less than in neutral. Rotated right and left, measured 12.3 (± 1.9) and 13.0 (±1.8) mm, respectively.

Conclusions: Greater tube-to-carina distance was observed with neck flexion. Subsequent research should confirm whether identifying tracheostomy tube tip location range reduces risk of mainstem tube misplacement, accidental decannulation, and need for tracheostomy up/downsizing. This preliminary work suggests the importance of performing tracheoscopy in multiple head/neck positions when assessing tracheostomy tube tip position.