There is very little research regarding when it is safe to do the first tracheostomy tube change. Commonly, the first tube change is done between post-op day 7-14. A study was just published in Critical Care Medicine and showed that it is safe to do the first tracheostomy change prior to post-op day 7.
The authors at Mass General in Boston enrolled 130 patients after a tracheostomy placement. Thirty-eight patients received a trach change prior to Day 7 (early group) and 92 patients received a trach change after Day 7 (late group). They found that the early group was more likely to be liberated from the ventilator on Day 7 (100% vs. 45%, p=0.0001), tolerate speaking valve earlier (7 vs. 12 days, p=0.001), more likely to tolerate earlier oral feeding (10 vs. 20 days, p=0.04), and had shorter length of stay (11 vs. 17 days, p=0.001). There was no difference in mortality and no complications associated with the trach change.
Source: Abstract: Fisher et al., (2011). Early tracheostomy change is associated with earlier use of speaking valve and earlier oral intake, Crit Care Med, 39(12), 515.
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