J Otolaryngol Head Neck Surg. 2026 Jan-Dec;55:19160216261485563. doi: 10.1177/19160216261485563. Epub 2026 Oct 13.

ABSTRACT

IMPORTANCE: Safe tracheostomy management requires specialized, coordinated care. Despite calls for standardization, persistent variability in clinical practice continues to expose patients to preventable morbidity and mortality. Canadian practice patterns have not been well described. An improved understanding of these patterns is an essential first step toward the development of standardized guidelines.

OBJECTIVE: To evaluate the recommendations provided by Canadian otolaryngologists to health care teams and patients, and to identify areas in which these recommendations varied substantially.

DESIGN: National cross-sectional survey.

SETTING: Canadian otolaryngology practices.

PARTICIPANTS: All 519 otolaryngologists currently practicing in Canada.

INTERVENTIONS: A bilingual (French and English) electronic survey was distributed between January and October 2025.

MAIN OUTCOME MEASURES: Descriptive statistics of self-reported tracheostomy care practices across 3 care phases (in-hospital management, preparation for discharge, and long-term care) focusing on recommendations for daily care, cuff deflation, oral intake initiation, and discharge strategies.

RESULTS: Of 519 otolaryngologists contacted, 163 (31.4%) responded and only 52.6% reported having institutional protocols. Although most respondents (87.7%) initially used non-fenestrated cuffed tubes (size 8 in men, 77.9%; size 6 in women, 82%), subsequent management varied substantially. Cuff deflation was most often guided by secretion control (56.5%). Recommendations for instillations and suctioning varied widely in frequency across both hospital and home settings. Inner cannula cleaning was recommended routinely by 77.3% in-hospital and 85.1% at home, typically 1 to 3 times daily. Humidification practices varied widely with no consensus regarding type or frequency. Prior to discharge, most required a care demonstration (86.3%) and provided caregiver training (78.2%) while fewer offered written instructions (45.5%). Only 42.9% reported using standardized discharge checklists.

CONCLUSION: This national survey highlights substantial variability in tracheostomy care practices among Canadian otolaryngologists from immediate postoperative care to long-term home management. While some areas of consensus exist, significant gaps persist in daily-care routines (eg, instillations and suctioning), humidification and discharge processes.

RELEVANCE: These findings underscore the need for national, evidence-based tracheostomy care guidelines. Future initiatives should prioritize developing standardized care pathways to reduce practice variability and promote more consistent tracheostomy management across Canadian care settings.

PMID:42867169 | DOI:10.1177/19160216261485563