National Survey of Fenestrated versus Non-Fenestrated Tracheostomy Tube Use and the Incidence of Surgical Emphysema in UK Adult Intensive Care Units

Surgical emphysema is a recognised complication of percutaneous tracheostomy (PT) and it has been shown that this is a particular problem when a fenestrated tracheostomy tube is initially used in patients receiving positive pressure ventilation. The recently published ‘Standards for the care of adult patients with a temporary tracheostomy’ produced by the Intensive Care Society UK (ICS) addresses this issue and states that ‘generally fenestrated tracheostomy tubes should not be used while a patient still requires mechanical ventilation because of significant risk of surgical emphysema’. We have conducted a survey of current UK practice to assess whether the guidelines are being followed. This primarily focused on choice of tracheostomy tube, the incidence of surgical emphysema and whether endoscopic confirmation of fenestration placement was performed. The results show that of the units that replied, eight (12%) still routinely insert fenestrated tracheostomy tubes, and all of these reported surgical emphysema as a complication. Only 16% check the position of the fenestrations within the tracheal lumen. In accordance with the ICS guidelines, it is important to use a non-fenestrated tracheostomy tube on initial insertion of PT, especially for patients that require positive pressure ventilation. Where a fenestrated tube is used, operational policies should be reviewed for checking the position and patency of the fenestrations.