CT Assessment of Laryngotracheal Changes After Surgical and Percutaneous Tracheostomy.

Abstract

To quantify laryngotracheal morphological changes after tracheostomy using CT, compare findings between surgical open tracheostomy (SOT) and percutaneous dilatational tracheostomy (PDT) in a chronically ventilated population and identify CT-based predictors of successful decannulation. Retrospective cohort study of 82 chronically ventilated patients who underwent CT ≥ 4 weeks after tracheostomy. Lumen areas were measured at the cricoid, suprastomal, and distal tracheal levels by standardized triplicate tracing. Cartilage fractures, stoma position, and wall thickness were characterized. Radiological predictors of decannulation were analyzed. Following tracheostomy, the cricoid lumen area decreased by 37% (mean difference: -88.9 mm², 95% CI: -113.2 to -64.6; p < 0.001) and the suprastomal lumen area by 53% (-135.1 mm², 95% CI: -160.2 to -110.0; p < 0.001). The distal tracheal lumen was unchanged (p = NS). Tracheal wall thickness increased from 1.93 to 2.89 mm (+0.96 mm, 95% CI: 0.80-1.12; p < 0.001). Cartilage fractures were identified in 63.4% of patients. In total, 22% of stomas were placed at or above the cricoid level. None of the 14 patients with cricoid-level stoma were successfully decannulated (0% vs. 29.4%; Fisher exact p = 0.016). Suprastomal fibrotic or cartilaginous block (partial or complete) was more common in non-decannulated patients (63.3% vs. 35.0%; Fisher exact p = 0.038; OR = 0.32, 95% CI: 0.11-0.92). No significant SOT-PDT differences were found in any outcome. Long-term tracheostomy causes significant laryngotracheal morphological changes with no structural differences between SOT and PDT. Cricoid-level stoma and suprastomal fibrotic block are significant predictors of decannulation failure, supporting CT assessment before or after failed decannulation to identify candidates for airway intervention.