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CoDAS 2019To perform a literature review on the existing international criteria and protocols for tracheostomy decannulation. (Review)
Review
PURPOSE
To perform a literature review on the existing international criteria and protocols for tracheostomy decannulation.
RESEARCH
strategies: Literature review using the PubMed database with the English keywords "Tracheostomy", "Weaning", "Decannulation", "Removal Tube", "Speech, Language and Hearing Sciences", "Intensive Care Units", "Dysphagia", "Swallowing", "Deglutition" and "Deglutition Disorders ".
SELECTION CRITERIA
Studies published in the last five years (2012 to 2017); studies with human adult population (i.e. ages above 18 years); articles published in English; unrestricted full access articles; and research related to the objectives of the study.
DATA ANALYSIS
we analyzed sample characterization; professionals involved in the decannulation process; steps of the decannulation process; total time in days of tracheostomy use; total time in days to complete decannulation process; and failure factors to complete the decannulation process.
RESULTS
Most of the studies investigated tracheostomy decannulation in a sample of males with neurological impairments. The professionals involved in the decannulation process were doctors, speech therapists, physiotherapists and nurses. The most cited decannulation steps were: swallowing assessment; occlusion training; evaluation of air permeability; ability to manipulate secretion and exchange of cannula; cuff deflation and cough training; use of speech valve.
CONCLUSION
Speech therapists are of great help during the decannulation process, since the assessment of swallowing was one of the decisive steps of the investigated studies. The processes of decannulation includes a multidisciplinary approach and should be performed by the cooperation between physicians, physiotherapists and speech therapists.
Topics: Airway Extubation; Deglutition Disorders; Device Removal; Female; Humans; Male; Respiration, Artificial; Tracheostomy; Ventilator Weaning
PubMed: 31800881
DOI: 10.1590/2317-1782/20192018228 -
BMJ Open Respiratory Research Jul 2020While there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies... (Review)
Review
OBJECTIVES
While 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.
DESIGN
Scoping review of the literature.
DATA SOURCES
PubMed, 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 CRITERIA
We 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 SYNTHESIS
Titles 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.
RESULTS
6132 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.
CONCLUSIONS
The 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.
Topics: Adult; Humans; Intensive Care Units; Patient Care Bundles; Patient Care Team; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency; Tracheostomy
PubMed: 32723731
DOI: 10.1136/bmjresp-2020-000651 -
Respiratory Care Jan 2021Management of patients with a tracheostomy tube includes many components of care provided by clinicians from various health care disciplines. In recent years, clinicians...
Management of patients with a tracheostomy tube includes many components of care provided by clinicians from various health care disciplines. In recent years, clinicians worldwide have demonstrated a renewed interest in the management of patients with tracheostomy due to the recognition that more effective and efficient management of this patient population is necessary to decrease morbidity and mortality and to optimize the value of the procedure. Commensurate with the goal of enhancing the care of patients with tracheostomy, we conducted a systematic review to facilitate the development of recommendations relevant to the care of adult patients with tracheostomy in the acute care setting. From our systematic review, clinical practice guidelines were developed to address questions regarding the impact of tracheostomy bundles, tracheostomy teams, and protocol-directed care on time to decannulation, length of stay, tracheostomy-related cost, tracheostomy-related adverse events, and other tracheostomy-related outcomes in tracheostomized adult patients in the acute care setting. Using a modification of the RAND/UCLA Appropriateness Method, 3 recommendations were developed to assist clinicians with tracheostomy management of adult patients in the acute care setting: (1) evidence supports the use of tracheostomy bundles that have been evaluated and approved by a team of individuals experienced in tracheostomy management to decrease time to decannulation, tracheostomy-related adverse events, and other tracheostomy-related outcomes, namely, improved tolerance of oral diet; (2) evidence supports the addition of a multidisciplinary tracheostomy team to improve time to decannulation, length of stay, tracheostomy-related adverse events, and other tracheostomy-related outcomes, namely, increased speaking valve use; (3) evidence supports the use of a weaning/decannulation protocol to guide weaning and removal of the tracheostomy tube to improve time to decannulation.
Topics: Adult; Critical Care; Device Removal; Humans; Systematic Reviews as Topic; Tracheostomy
PubMed: 32962998
DOI: 10.4187/respcare.08206 -
American Journal of Critical Care : An... Nov 2022In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. (Meta-Analysis)
Meta-Analysis
BACKGROUND
In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries.
OBJECTIVE
To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting.
METHODS
MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria.
RESULTS
Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury.
CONCLUSIONS
Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.
Topics: Adult; Child; Humans; Bandages; Critical Care; Critical Illness; Intensive Care Units; Tracheostomy; Pressure Ulcer
PubMed: 36316177
DOI: 10.4037/ajcc2022659 -
Otolaryngologic Clinics of North America Dec 2022Advances in neonatal and pediatric critical care have resulted in a growing population of medically complex children with a tracheostomy. These children are vulnerable... (Review)
Review
Advances in neonatal and pediatric critical care have resulted in a growing population of medically complex children with a tracheostomy. These children are vulnerable to adverse events from underlying comorbidities, risks of tracheostomy, equipment malfunction, and caregiver inexperience. Multidisciplinary tracheostomy teams have emerged as effective initiatives to address these patient safety concerns. Improvements in quality metrics and clinical outcomes can occur after implementation of a multidisciplinary tracheostomy team. This review provides updates on the evidence for multidisciplinary pediatric tracheostomy teams and offers perspectives on the future direction of these programs.
Topics: Infant, Newborn; Child; Humans; Tracheostomy; Quality Improvement; Patient Safety; Critical Care; Comorbidity
PubMed: 36371135
DOI: 10.1016/j.otc.2022.07.005 -
Current Opinion in Otolaryngology &... Dec 2020The aim of this review is to provide an update on the management of pediatric tracheostomies. (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to provide an update on the management of pediatric tracheostomies.
RECENT FINDINGS
Recent literature has focused on optimization of care for children with tracheostomies including prevention and management of skin breakdown, timing of tracheostomy tube changes, the role of multidisciplinary and team-based approaches to education and management of tracheostomy patients, ideal timing of surveillance endoscopy, and the emerging role of telemedicine in the care of tracheostomy patients.
SUMMARY
A focus on quality improvement and a systematic, team-based approach to care has the potential to improve the quality of care for pediatric tracheostomy patients.
Topics: Child; Humans; Patient Care Team; Postoperative Complications; Quality Improvement; Tracheostomy
PubMed: 33027138
DOI: 10.1097/MOO.0000000000000666 -
Auris, Nasus, Larynx Jun 2024Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages,... (Review)
Review
Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages, starting at 0. In addition, advances in surgical techniques and postoperative tube management have reduced complications. This review will discuss the entire process of pediatric tracheostomy, starting with the history of tracheostomy and ending with indications, contraindications, techniques (slit, Björk, EXIT), complications, tube management, and decannulation. Pediatric tracheostomy patients require long-term care and management as they grow after the surgery itself, so otolaryngologists and pediatric tracheostomists are particularly involved in tube management and decannulation. We believe that sharing this information with all healthcare professionals will lead to better care for children with tracheostomies.
Topics: Humans; Tracheostomy; Child; Infant; Infant, Newborn; Child, Preschool; Postoperative Complications; Device Removal; Contraindications, Procedure; History, 19th Century; History, 20th Century
PubMed: 38520972
DOI: 10.1016/j.anl.2024.01.003 -
Zentralblatt Fur Chirurgie Jun 2022Even in specialised centres, surgical procedures on the airway are only rarely performed in paediatric patients. Moreover, knowledge of various specific anatomical... (Review)
Review
Even in specialised centres, surgical procedures on the airway are only rarely performed in paediatric patients. Moreover, knowledge of various specific anatomical characteristics, diseases and surgical techniques is a prerequisite to treat these patients. Most commonly, sequelae of long-term intubation or tracheostomy in multimorbid patients necessitate surgical repair. Moreover, congenital malformations of the airways might require surgical interventions. However, these are commonly associated with other organ malformations, which adds further complexity to the treatment concept. Thus, cooperation within an interdisciplinary team is absolutely necessary to treat these patients. However, good postoperative outcomes after paediatric airway surgery can be achieved in experienced centres with an appropriate infrastructure. Specifically, this means long-term tracheostomy-free survival with preserved laryngeal functions in most of the patients. This review provides a summary of common indications and surgical techniques in paediatric airway surgery.
Topics: Child; Humans; Intubation, Intratracheal; Specialties, Surgical; Tracheostomy
PubMed: 35104899
DOI: 10.1055/a-1727-6196 -
The New England Journal of Medicine Nov 2020
Topics: Aftercare; Contraindications, Procedure; Humans; Tracheostomy
PubMed: 33113296
DOI: 10.1056/NEJMvcm2014884 -
British Journal of Nursing (Mark Allen... Sep 2019
Topics: Humans; Tracheostomy
PubMed: 31518528
DOI: 10.12968/bjon.2019.28.16.1060