When to change a tracheostomy tube.

Knowing when to change a tracheostomy tube is important for optimal management of all patients with tracheostomy tubes. The first tracheostomy tube change, performed 1-2 weeks after placement, carries some risk and should be performed by a skilled operator in a safe environment. The risk associated with changing the tracheostomy tube then usually diminishes over time as the tracheo-cutaneous tract matures. A malpositioned tube can be a source of patient distress and patient-ventilator asynchrony, and is important to recognize and correct. Airway endoscopy can be helpful to ensure optimal positioning of a replacement tracheostomy tube. Some of the specialized tracheostomy tubes available on the market are discussed. There are few data available to guide the timing of routine tracheostomy tube changes. Some guidelines are suggested.