Impact of a multidisciplinary tracheostomy care team on tracheostomy care in the general wards

Huang, Agnes

doi:10.1016/j.jcrc.2015.04.030

Cited by 5 publications

(9 citation statements)

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“…In this study, we have demonstrated that glucocorticoids exert a specific inhibitory effect on the induction of the expression of two chemoattractants involved in neutrophil recruitment (Il8 and Cxcl18b). Using in vitro and in vivo models, it has been demonstrated that human and mouse neutrophil migration is dependent on the induction of Il8 expression (Godaly et al, 2000; Huber et al, 1991; Kaunisto et al, 2015) and that this induction is inhibited by glucocorticoids (Huang et al, 2015; Keelan et al, 1997; Yano et al, 2006). In mammals, Il8 has been demonstrated to signal through the chemokine receptors Cxcr1 and Cxcr2, whereas in zebrafish only Cxcr2 has been shown to mediate the effects of Il8 (Brugman, 2016; Torraca et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoids inhibit macrophage differentiation towards a pro-inflammatory phenotype upon wounding without affecting their migration

Xie

Tolmeijer

Oskam

et al. 2019

Disease Models &Amp; Mechanisms

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Glucocorticoid drugs are widely used to treat immune-related diseases, but their use is limited by side effects and by resistance, which especially occurs in macrophage-dominated diseases. In order to improve glucocorticoid therapies, more research is required into the mechanisms of glucocorticoid action. In the present study, we have used a zebrafish model for inflammation to study glucocorticoid effects on the innate immune response. In zebrafish larvae, the migration of neutrophils towards a site of injury is inhibited upon glucocorticoid treatment, whereas migration of macrophages is glucocorticoid resistant. We show that wounding-induced increases in the expression of genes that encode neutrophil-specific chemoattractants (Il8 and Cxcl18b) are attenuated by the synthetic glucocorticoid beclomethasone, but that beclomethasone does not attenuate the induction of the genes encoding Ccl2 and Cxcl11aa, which are required for macrophage recruitment. RNA sequencing on FACS-sorted macrophages shows that the vast majority of the wounding-induced transcriptional changes in these cells are inhibited by beclomethasone, whereas only a small subset is glucocorticoid-insensitive. As a result, beclomethasone decreases the number of macrophages that differentiate towards a pro-inflammatory (M1) phenotype, which we demonstrated using a tnfa:eGFP-F reporter line and analysis of macrophage morphology. We conclude that differentiation and migration of macrophages are regulated independently, and that glucocorticoids leave the chemotactic migration of macrophages unaffected, but exert their anti-inflammatory effect on these cells by inhibiting their differentiation to an M1 phenotype. The resistance of macrophage-dominated diseases to glucocorticoid therapy can therefore not be attributed to an intrinsic insensitivity of macrophages to glucocorticoids.

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Section: Discussionmentioning

confidence: 99%

Glucocorticoids inhibit macrophage differentiation towards a pro-inflammatory phenotype upon wounding without affecting their migration

Xie

Tolmeijer

Oskam

et al. 2019

Disease Models &Amp; Mechanisms

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“…Traditional anti-inflammatory treatments that focus on the inhibition of prostaglandin synthesis, such as nonsteroidal anti-inflammatory drugs or glucocorticoids, impair wound healing [47]. However, steroid administration has been shown to reduce inflammation, pain, and length of hospital stay in burn patients in several small studies [48, 49]. Early excision and grafting has become the gold standard for treatment of full and deep partial thickness burns [50, 51], in part because early excision helps reduce the risk of infection and scarring [52–54].…”

Section: Optimization Of Burn Wound Healingmentioning

confidence: 99%

Burn wound healing and treatment: review and advancements

et al. 2015

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Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.

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“…Over the past decade, a growing cohort of institutions have reported positive outcomes after the coordination of MDTs. [6][7][8][9] These teams comprise members from multiple specialties, including otolaryngology, pulmonary medicine, intensive care, respiratory therapy, nursing, and speech and language pathology. Primary outcomes established by tracheostomy MDTs include time to decannulation, length of intensive care unit and total hospital stays, frequency of adverse events, and speaking valve and/or swallowing trials.…”

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confidence: 99%

“…[5][6][7][8][9] Many studies have shown improvement in 1 or more of these metrics with multidisciplinary care. [6][7][8][9] However, quality metrics used in adult tracheostomy populations are not applicable in pediatric settings because the underlying indications for tracheostomy and feasibility of eventual decannulation are typically different in children. There is a sparsity of literature assessing the association between multidisciplinary tracheostomy care and the pediatric population.…”

mentioning

confidence: 99%

“…Primary outcomes established by tracheostomy MDTs include time to decannulation, length of intensive care unit and total hospital stays, frequency of adverse events, and speaking valve and/or swallowing trials. [5][6][7][8][9] Many studies have shown improvement in 1 or more of these metrics with multidisciplinary care. [6][7][8][9] However, quality metrics used in adult tracheostomy populations are not applicable in pediatric settings because the underlying indications for tracheostomy and feasibility of eventual decannulation are typically different in children.…”

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confidence: 99%

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Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

McKeon

Kohn

Munhall

et al. 2019

JAMA Otolaryngol Head Neck Surg

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placement in children is increasing, and these children continue to have high incidences of morbidity and mortality. A multidisciplinary tracheostomy program may help improve the quality of care received by these patients.OBJECTIVE To determine whether implementation of a multidisciplinary tracheostomy program can improve the care of children who received a tracheostomy through reduction in tracheostomy-related adverse events (TRAEs), improved tracheostomy education, and caregiver preparedness. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study was conducted from January 2015 to June 2018 at a pediatric tertiary referral center in Boston, Massachusetts. The participants included 700 children who had received a tracheostomy, most of whom were aged birth to 18 years, but some patients with congenital disorders were much older.EXPOSURES Institution of a multidisciplinary tracheostomy team (MDT) whose activities included conducting staff meetings, organizing outpatient clinics, conducting inpatient tracheostomy ward rounds, and conducting inpatient tracheostomy rounds at a local rehabilitation hospital. Quality improvement initiatives included monitoring standardized TRAEs and distributing standardized tracheostomy "go-bags."MAIN OUTCOMES AND MEASURES Reduction of TRAEs and improved caregiver preparedness through distribution of tracheostomy go-bags were assessed following the establishment of a multidisciplinary tracheostomy program. RESULTSIn total, 700 children who had received a tracheostomy during the study period were actively followed up by the MDT. Of these children, 378 (54.0%) were males and 322 (46.0%) were females; mean (SD) age was 4.1 (6.1) years. More than 60 new pediatric tracheostomies were performed annually at the referral center. Reported TRAEs were reduced by 43.0% from the first to the third year after the implementation of a standardized, closed-loop monitoring system (from a mean [SD] of 6.1 [5.2] TRAEs per 1000 inpatient tracheostomy-days in 2015 to a mean [SD] of 4.0 [2.5] in 2018). The most common TRAE was unplanned decannulation, which occurred 64 times during the study period. On average, 10 patients were seen in each monthly multidisciplinary tracheostomy clinic. Clinic interventions included continuing care (146 [52.5%]), communication enhancement (67 [23.6%]), plans for decannulation (52 [18.6%]), and referrals for comorbidities (13 [4.6%]). Approximately 19 inpatients were seen during biweekly rounds and 8 during monthly rounds at a local rehabilitation hospital. A total of 297 patients received standardized tracheostomy go-bags, and more than 70 positive bag checks were performed in the monthly MDT clinics. A positive bag check refers to the incidence when a family is given a go-bag and also uses it. In contrast, a negative bag check refers to when a family is given a go-bag but neither brings it to the clinic nor acknowledges that they use it.CONCLUSIONS AND RELEVANCE This study's findings suggest that a multidisciplinary tracheostomy program may be a powerful tool for enha...

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Impact of a multidisciplinary tracheostomy care team on tracheostomy care in the general wards

Cited by 5 publications

References 0 publications

Glucocorticoids inhibit macrophage differentiation towards a pro-inflammatory phenotype upon wounding without affecting their migration

Glucocorticoids inhibit macrophage differentiation towards a pro-inflammatory phenotype upon wounding without affecting their migration

Burn wound healing and treatment: review and advancements

Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

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