"Trach time"

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Specializes in PICU.

I have a question for adult ICU nurses....

I work in PICU and have noticed (from the few adult cases I have heard of and seen) that the timing for a patient getting a trach seems dramatically different in adults vs. peds. In peds if we have a child that has been intubated for a while they do eventually get a trach but we usually let them go about 3-4 weeks before traching them. The situation may vary and they may get a trach sooner if it is obvious they need one for long term airway or if it will obviously move their recovery along. Anyway, I was wondering what the timing was with adults (my impression was that it was much fast like a week or 2) and why. Just curious...

Thanks!

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where I work, decision about a trach is largely physician dependent . . . some of the intensivists will trach fairly quickly (7 days) when it is clear that the patient will be in ICU for a long time and will require vent support long term

but, others will let it go 2 weeks, 3 weeks . . . I guess hoping that a miracle "turn around" will occur, and then finally agree to trach

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Specializes in NICU.

We hardly ever let patient's go longer than 2 1/2 weeks. Some patients get trachs sooner if it is obvious they'll have a longer recovery period.

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where I work, decision about a trach is largely physician dependent . . . some of the intensivists will trach fairly quickly (7 days) when it is clear that the patient will be in ICU for a long time and will require vent support long term

but, others will let it go 2 weeks, 3 weeks . . . I guess hoping that a miracle "turn around" will occur, and then finally agree to trach

>That has been the majority of my experience as well, variable dependent on the physician. One place had a hard and fast rule, on the 7th day intubated they got trached........can you guess how many people I weaned on the 8th or 9th day?!?! As far as the peds go, I believe a cuffless ETT can stay in place longer with less injury caused to the airway.

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It's very case-dependent. If you asked for an an average though I'd say 2 weeks for someone who's been failing weaning trials consistently. I've seen many people trach'd and then transfered back us for a capping trial and they did fine, so it's not to say our physicians always make the right call. Some people are just tough cookies and need more time to get their act together and breathe!

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Specializes in Adult ER, Medical ICU.
It's very case-dependent. If you asked for an an average though I'd say 2 weeks for someone who's been failing weaning trials consistently. I've seen many people trach'd and then transfered back us for a capping trial and they did fine, so it's not to say our physicians always make the right call. Some people are just tough cookies and need more time to get their act together and breathe!

I find our practice in my hospital is similar to detroitdano's. Generally we give 2 weeks and attempt weaning.. After that if the patient continues to fail trials the discussion about trach begins. If there is obvious need beforehand, then attempts are made to start discussions earlier.. Very rarely they will give someone an extra few days or a week if there are musculoskeletal issues that may improve with specific treatments and need time to respond.

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Specializes in ICU, ER.

It's very patient-specific and depends on the doctor, but generally around 1.5-2 weeks

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