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Q. My father is in coma. Tracheostomy has been done. Is it safe to remove tracheostomy at this stage?

Answered by
Dr. Divakara P
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 13, 2014 and last reviewed on: Jan 20, 2022

Hello doctor,

My father is in coma.

Tracheostomy has been done.

He is off the ventilator, but has coughing problems.

His GCS is 7.

Is it safe to remove tracheostomy at this stage?

 

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#

Hi, Welcome to icliniq.com.

  • If his breathing pattern is normal and he is maintaining oxygen saturation in normal limits, he can be considered for tracheostomy closure
  • But if there is no significant improvement in GCS (Glasgow Coma Scale) or if not expected to improve, then better remove the tracheostomy.
  • If improvement is expected, then better to avoid removal of tracheostomy.

Consult a criticalcare physician online for further help --> https://www.icliniq.com/ask-a-doctor-online/criticalcare-physician

Thank You Doctor for your quick response.

  • I have some more questions related to tracheostomy tube size.
  • Can you let me know the criteria for tracheostomy tube size selection?
  • Right now he is having tube 5 size.
  • But the doctor is going to replace it again by 6.5.
  • I want to know which size would be convenient for him.
  • Because according to the nursing staff, suctioning is not done properly, secretion is not removed properly as the size of the tube is small.
  • So they find it difficult and so the risk of cough increases.
  • While on the other hand, the doctor is forcing to reduce the size.
  • We feel that our patient is not comfortable with the bigger size, as it irritates him a lot.
  • He is comfortable with size 5 with minimum suctioning.
  • So we are totally confused.

I will greatly appreciate any guidance that you can lend.

Thank you in advance, for your help. I look forward to hearing from you at your earliest convenience.

#

Hi,

  • The selection of size for tracheostomy tube depends on the patient's parameters like length of trachea, distance of carina from tracheostomy site, whether a high tracheostomy was done or low. 
  • I think the doctor is the best judge of it.
  • Even I feel (though I may be wrong) that size of 5 is small. 
  • Also a larger tube wil help in better suctioning and less chance of tube obstruction
  • My advice is you can go ahead with tube change with a larger tube.
  • A larger tube also causes less irritation while suctioning and thus more frequent suctioning can be done with less patient discomfort.

Consult a criticalcare physician online for further help --> https://www.icliniq.com/ask-a-doctor-online/criticalcare-physician


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