1214: The Positive Impact of Multidisciplinary Tracheostomy Team in the Care of Post-Tracheostomy Patients

Santos, Ariel; Harper, David; Gandy, Susan; Buchanan, Buffy

doi:10.1097/01.ccm.0000529218.20247.15

Cited by 2 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 In our own center, we have documented that the proportion of percutaneous tracheostomies has increased over time in comparison with the open technique from 80% to 85% in 2009 to 91% in our current study. 5 Considering timing of tracheostomy, the procedure was performed at a median of 8 days from ICU admission, consistent with previous data from our own center. 5…”

Section: Discussionsupporting

confidence: 81%

“…5 Considering timing of tracheostomy, the procedure was performed at a median of 8 days from ICU admission, consistent with previous data from our own center. 5…”

Section: Discussionsupporting

confidence: 81%

“…This is in keeping with previous results from our center and emphasizes the MTT in enhancing and progressing patient care. 5…”

Section: Discussionmentioning

confidence: 99%

“…4 We have already demonstrated that introduction of a multidisciplinary tracheostomy team (MTT) has reduced time to decannulation. 5 We now want to ascertain if our tracheostomy patients are achieving the goals that are important to them—those that relate to communication, mobility, and swallow, de-escalation to lower dependency units allowing progression of rehabilitation and social mixing. Obtaining this information will help better delineate the benefits associated with tracheostomy use to aid in the decision-making process surrounding tracheostomy insertion and timing and identify areas for improvement in the care of patients who undergo a tracheostomy in the future.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Patient-Centred Outcomes Following Tracheostomy in Critical Care

Mahon

Griffin

Gorman

et al. 2023

J Intensive Care Med

View full text Add to dashboard Cite

Introduction Around 20% of intensive care unit (ICU) patients undergo tracheostomy insertion and expect high-quality care concentrating on patient-centered outcomes including communication, oral intake, and mobilization. The majority of data has focused on timing, mortality, and resource utilization, with a paucity of information on quality of life following tracheostomy. Methods Single center retrospective study including all patients requiring tracheostomy from 2017 to 2019. Information collected on demographics, severity of illness, ICU and hospital length of stay (LOS), ICU and hospital mortality, discharge disposition, sedation, time to vocalization, swallow and mobilization. Outcomes were compared for early versus late tracheostomy (early = <day 10) and age category (≤ 65 vs ≥ 66 years). Results In total, 304 patients were included and 71% male, median age 59, APACHE II score 17. Median ICU and hospital LOS 16 and 56 days, respectively. ICU and hospital mortality 9.9% and 22.4%. Median time to tracheostomy 8 days, 8.55% open. Following tracheostomy, median days of sedation was 0, time to noninvasive ventilation (NIV) 1 day (94% of patients achieving this), ventilator-free breathing (VFB) 5 days (72%), speaking valve 7 days (60%), dynamic sitting 5 days (64%), and swallow assessment 16 days (73%). Early tracheostomy was associated with shorter ICU LOS (13 vs 26 days, P < .0001), reduced sedation (6 vs 12 days, P < .0001), faster transition to level 2 care (6 vs 10 days, P < .003), NIV (1 vs 2 days, P < .003), and VFB (4 vs 7 days, P < .005). Older patients received less sedation, had higher APACHE II scores and mortality (36.1%) and 18.5% were discharged home. Median time to VFB was 6 days (63.9%), speaking valve 7 days (64.7%), swallow assessment 20.5 days (66.7%), and dynamic sitting 5 days (62.2%). Conclusion Patient-centered outcomes are a worthy goal to consider when selecting patients for tracheostomy in addition to mortality or timing alone, including in older patients.

show abstract

Section: Discussionsupporting

confidence: 81%

“…5 Considering timing of tracheostomy, the procedure was performed at a median of 8 days from ICU admission, consistent with previous data from our own center. 5…”

Section: Discussionsupporting

confidence: 81%

“…This is in keeping with previous results from our center and emphasizes the MTT in enhancing and progressing patient care. 5…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patient-Centred Outcomes Following Tracheostomy in Critical Care

Mahon

Griffin

Gorman

et al. 2023

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…84 Four studies (including three abstracts) evaluated the impact of multidisciplinary tracheostomy teams, finding they resulted in reduced time to first oral intake, first tube change and decannulation, and reduced length of stay and complication rates. [85][86][87][88] Reduced time to weaning and decannulation were noted in three of the four studies. 85 87 88 Three studies including one abstract addressed quality of life or stressful experiences, with patients reporting that psychosocial discomfort, sleeplessness, physical symptoms of thirst and pain, fear and relationships had a significant impact on their experience.…”

Section: Optimisation Of Swallowmentioning

confidence: 99%

Management of tracheostomies in the intensive care unit: a scoping review

2020

View full text Add to dashboard Cite

ObjectivesWhile there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies within the intensive care unit (ICU) from after insertion until ICU discharge is not well understood. The objective was to identify and map the key concepts relating to, and identify research priorities for, postinsertion management of adult patients with tracheostomies in the ICU.DesignScoping review of the literature.Data sourcesPubMed, Embase and Cumulative Index to Nursing and Allied Health Literature were searched from inception to 3 October 2019. Additional sources were searched for published and unpublished literature.Eligibility criteriaWe included studies of any methodology that addressed the a priori key questions relating to tracheostomy management in the ICU. No restrictions were placed on language or year of publication.Data extraction and synthesisTitles and abstracts were screened by two reviewers. Studies that met inclusion criteria were reviewed in full by two reviewers, with discrepancies resolved by a third. Data were extracted for included studies, and results mapped along the prespecified research questions.Results6132 articles were screened, and 102 articles were included for detailed analysis. Protocolised weaning was found to be successful in liberating patients from the ventilator in several cohort studies. Observational studies showed that strategies that use T-pieces and high-flow oxygen delivery improve weaning success. Several lines of evidence, including one clinical trial, support early cuff deflation as a safe and effective strategy as it results in a reduced time to wean, shorter ICU stays and fewer complications. Early tracheostomy downsizing and/or switching to cuffless tubes was found to be of benefit in one study. A substantial body of evidence supports the use of speaking valves to facilitate communication. While this does not influence time to wean or incidence of complications, it is associated with a major benefit in patient satisfaction and experience. Use of care bundles and multidisciplinary team approaches have been associated with reduced complications and improved outcomes in several observational studies.ConclusionsThe limited body of evidence supports use of weaning protocols, early cuff deflation, use of speaking valves and multidisciplinary approaches. Clinical trials examining post-tracheostomy management strategies in ICUs are a priority.

show abstract

1214: The Positive Impact of Multidisciplinary Tracheostomy Team in the Care of Post-Tracheostomy Patients

Cited by 2 publications

References 0 publications

Patient-Centred Outcomes Following Tracheostomy in Critical Care

Patient-Centred Outcomes Following Tracheostomy in Critical Care

Management of tracheostomies in the intensive care unit: a scoping review

Contact Info

Product

Resources

About