CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(03): e407-e414
DOI: 10.1055/s-0043-1776723
Original Research

Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center

1   Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Elsa Maria Chahine
2   American University of Beirut, Beirut, Lebanon
Randa Barazi
1   Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
› Author Affiliations
Funding The authors declare that they have not received funding to conduct the present study.


Introduction The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe.

Objective To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively.

Methods The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change.

Results The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes (p = 0.688), or between pediatric and adult subjects (p = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = −0.014; p = 0.84 for the first change; and r = −0.57; p = 0.64 for the second change).

Conclusion The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.


The current article was presented at the 17th Annual Meeting of the Middle East Academy of Otolaryngology Head and Neck Surgery, Dubai, United Arab Emirates, March 17–19, 2022, and won first place at the Heinz Stammberger Resident Research Competition.

Authors' Contributions

CAZD: data collection, analysis, writing, and presentation of the research; EMC: data collection; RB: design, conduct, and manuscript editing and revision.

Publication History

Received: 19 March 2023

Accepted: 14 July 2023

Article published online:
27 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • References

  • 1 De Leyn P, Bedert L, Delcroix M. et al; Belgian Association of Pneumology and Belgian Association of Cardiothoracic Surgery. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg 2007; 32 (03) 412-421
  • 2 Lewarski JS. Long-term care of the patient with a tracheostomy. Respir Care 2005; 50 (04) 534-537
  • 3 Lippert D, Hoffman MR, Dang P, McMurray JS, Heatley D, Kille T. Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change. Int J Pediatr Otorhinolaryngol 2014; 78 (12) 2281-2285
  • 4 Zebda D, Anderson B, Huang Z, Yuksel S, Roy S, Jiang ZY. Early Tracheostomy Change in Neonates: Feasibility and Benefits. Otolaryngol Head Neck Surg 2021; 165 (05) 716-721
  • 5 White AC, Kher S, O'Connor HH. When to change a tracheostomy tube. Respir Care 2010; 55 (08) 1069-1075
  • 6 Yaremchuk K. Regular tracheostomy tube changes to prevent formation of granulation tissue. Laryngoscope 2003; 113 (01) 1-10
  • 7 Backman S, Björling G, Johansson UB. et al. Material wear of polymeric tracheostomy tubes: a six-month study. Laryngoscope 2009; 119 (04) 657-664
  • 8 Chorney SR, Patel RC, Boyd AE. et al. Timing the First Pediatric Tracheostomy Tube Change: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2021; 164 (04) 869-876
  • 9 Mitchell RB, Hussey HM, Setzen G. et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg 2013; 148 (01) 6-20
  • 10 Meister KD, Pandian V, Hillel AT. et al. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164 (05) 984-1000
  • 11 Parker N, Schiff B, Fritz M. et al. AAO Position Statement: Tracheotomy Recommendations During the COVID-19 Pandemic2021. Available from:
  • 12 Van Buren NC, Narasimhan ER, Curtis JL, Muntz HR, Meier JD. Pediatric tracheostomy: timing of the first tube change. Ann Otol Rhinol Laryngol 2015; 124 (05) 374-377
  • 13 Dal'Astra AP, Quirino AV, Caixêta JA, Avelino MA. Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades. Rev Bras Otorrinolaringol (Engl Ed) 2017; 83 (02) 207-214
  • 14 Carron JD, Derkay CS, Strope GL, Nosonchuk JE, Darrow DH. Pediatric tracheotomies: changing indications and outcomes. Laryngoscope 2000; 110 (07) 1099-1104
  • 15 Carr MM, Poje CP, Kingston L, Kielma D, Heard C. Complications in pediatric tracheostomies. Laryngoscope 2001; 111 (11 Pt 1): 1925-1928
  • 16 Fernandez-Bussy S, Mahajan B, Folch E, Caviedes I, Guerrero J, Majid A. Tracheostomy Tube Placement: Early and Late Complications. J Bronchology Interv Pulmonol 2015; 22 (04) 357-364
  • 17 Internal analysis of GHX data from Q4 CY2017, Tracheostomy GHX market share. GHX; 2018