What is my trach score (tracheostomy score)?

Understanding "Trach Score"

There is no validated clinical scoring system called a "trach score" or "tracheostomy score" in the medical literature or established guidelines. You may be referring to one of several different concepts related to tracheostomy care.

Possible Interpretations

1. Tracheostomy Red Flags Assessment

The most clinically relevant "scoring" approach involves recognizing warning signs that indicate potential tracheostomy emergencies 1:

Airway Red Flags:

• Sudden ability to talk when previously had minimal leak, audible air leaks, or bubbles at mouth 1
• Suction catheter not passing through tracheostomy 1
• Grunting, snoring, or stridor 1

Breathing Red Flags:

• Apnea or cessation of breathing 1
• Increasing ventilator support or oxygen requirements 1
• Respiratory distress with accessory muscle use, increased respiratory rate, higher airway pressures, or lower tidal volumes 1

Tracheostomy-Specific Red Flags:

• Visibly displaced tracheostomy tube 1
• Blood or blood-stained secretions around the tube 1
• Increased discomfort or pain 1

General Physiological Red Flags:

• Changes in respiratory rate, heart rate, blood pressure, or level of consciousness 1
• Anxiety, restlessness, agitation, or confusion (may indicate airway problem) 1

2. Complication Risk Stratification

If you're asking about predicting complications, the American Thoracic Society identifies several risk factors 1:

Higher Risk Groups:

• Young children (< 1-3 years of age) have more complications than older children 1
• Premature infants have more problems than full-term babies 1
• Emergency tracheostomies have 75% complication rate versus 35% for elective procedures 1
• Patients without pre-existing artificial airway have 55% versus 35% complication rate 1
• Infants under 3,000g have 44% versus 35% complication rate 1

Duration-Related Risk:

• Length of cannulation directly correlates with late complications: 11% if tracheostomy < 100 days, 55% for 101-500 days, and 80% for > 500 days 1

3. Tracheostomy Maturity Timeline

Critical safety consideration: Percutaneous tracheostomy stomas are not mature enough for safe tube exchange until 7-10 days post-procedure 1. During this early period, management of tube blockage or displacement should focus on securing the native upper airway rather than attempting stoma re-cannulation 1, 2.

Clinical Action Points

If you're assessing a patient with tracheostomy concerns:

• Immediately check for red flags listed above 1
• Pass a soft suction catheter to confirm tube patency (never use stiff bougies) 1, 2
• Apply waveform capnography if available 1
• Have emergency equipment at bedside: suction, oxygen, manual resuscitation bag, complete tracheostomy kit 3

If the patient is deteriorating and suction catheter won't pass: remove the tracheostomy tube immediately 1, 4, 2. A non-functioning tracheostomy offers no benefit and considerable potential for harm 1.