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At least 19 recordsLinked to original sources
PubMed2026

Comparison of Adult Tracheostomy Outcomes Before and After Implementation of a Dedicated Tracheostomy Team.

OBJECTIVE: (A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN: Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. PARTICIPANTS: Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. METHODS: Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. RESULTS: Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD&#x2009;=&#x2009;28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316]&#x2009;=&#x2009;28.706, P&#x2009;<&#x2009;.001]) and complication odds (OR&#x2009;=&#x2009;2.92, P&#x2009;=&#x2009;.015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (&#x3b2;&#x2009;=&#x2009;.253, t(314)&#x2009;=&#x2009;4.741, P&#x2009;<&#x2009;.001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (&#x3b2;&#x2009;=&#x2009;.406, t(184)&#x2009;=&#x2009;6.321, P&#x2009;<&#x2009;.001, 95% CI[.928, 1.771]); (&#x3b2;&#x2009;=&#x2009;.554, t(129)&#x2009;=&#x2009;7.625, P&#x2009;<&#x2009;.001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days (P&#x2009;=&#x2009;.586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 (P&#x2009;=&#x2009;.344). CONCLUSIONS: Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. LEVEL OF EVIDENCE: 4.

Humans↗
PubMed1997

Scrutinizing data helps team target high-cost DRGs, improve costly tracheostomy care.

Targeting high-cost DRGs using data collection, analysis: A hospital team analyzed DRGs with the highest excess charges and found DRG 483 (tracheostomy) had astronomical charges. Here's the step-by-step story of how they analyzed individual physician resource utilization, care progression through the hospital, and admission source to identify areas for clinical improvement, plus their findings and how they're putting them to use to improve care and reduce costs.

Benchmarking↗
PubMed2001

Tracheostomy management in the chronically ventilated patient.

Tracheotomy is a fundamentally important technique for managing patients who require long-term mechanical ventilation. Appropriate application of tracheotomy requires a skilled approach for timing the procedure, selecting the appropriate tracheostomy tube appliance, caring for the artificial airway once it is in place, and assisting patients with their specialized needs, such as articulated speech, airway humidification, and oral nutrition. Preparing patients for airway decannulation after they have weaned from mechanical ventilation requires a similar level of skill and attention to detail.

Critical Care↗
PubMedDate not supplied

Improving tracheostomy care for ward patients.

The number of patients with a tracheostomy being cared for in the ward setting has increased recently as intensive care clinicians use this procedure to aid early weaning from mechanical ventilation. As a result, ward staff are providing the specialist care required by patients with a tracheostomy more frequently. This article describes how the outreach team and the critical care practice development nurse in one trust collaborated to identify, develop and implement strategies to ensure that patients with a tracheostomy in the ward setting would be cared for by an educated and supported team of nurses.

Audiovisual Aids↗
PubMed2005

[Care for children with tracheostomy].

BACKGROUND: Modern technology has improved the quality of life for children with tracheostomy and home ventilators. MATERIAL AND METHODS: A "home ventilator team" at St. Olav University Hospital was responsible for 18 children with tracheostomy over a period of 2.5 years. The team serves as a link between different health care providers. A new educational programme for health care providers and parents is described. RESULTS AND INTERPRETATION: Children with tracheostomy constitute a small, but professionally challenging group with a variety of health-related problems. In Norway it is not quite clear who is responsible for the care of these patients.

Adolescent↗
PubMed2000

Successful EXIT (ex utero intrapartum treatment) procedure in a fetus diagnosed prenatally with congenital high-airway obstruction syndrome due to laryngeal atresia.

Congenital high-airway obstruction syndrome (CHAOS) is due to rare malformations and has been reported previously in only few cases. If the diagnosis can be made prenatally, the ex utero intrapartum treatment (EXIT) procedure may be life-saving. A healthy 28-year old nulli-para was referred because of isolated ascites found at gestational week 16 during routine ultrasound scan. Repeated scans showed overdistended hyperechogenic lungs with inverted diaphragm and a dilated trachea, which was interpreted as a CHAOS resulting from laryngeal atresia. The ascites eventually disappeared. An EXIT procedure was performed at 35 weeks of gestation. Anesthesia of the mother was induced with thiopental, succinylcholine and fentanyl followed by intubation, and maintained with isoflurane and nitrous oxide. A low abdominal midline incision was performed followed by a low transverse incision of the uterus. The fetal head, right arm and shoulder were delivered and intramuscular anesthesia was administered to the fetus. Immediate laryngoscopy confirmed the diagnosis and a tracheostomy was therefore performed. Surfactant was given after a few minutes of ventilation. Compliance improved and when the fetus was easy to ventilate, it was delivered. The baby is developing normally at 18 months of age. Surgical correction of the malformation will be performed after two years of age. It is concluded that some fetuses with a prenatal diagnosis of CHAOS can benefit from the EXIT procedure at delivery. This necessitates a multidisciplinary management team.

Adult↗
PubMedDate not supplied

Providing the nurse with a guide to tracheostomy care and management.

To care for a patient with a tracheostomy requires a clear understanding of each patient's need for the tracheostomy and the type of tube that is required. The impact of a tracheostomy on the respiratory system includes thorough knowledge of respiration, methods of humidification and also suctioning techniques. In addition to this a tracheostomy may impact on swallowing, communication and body image. Appreciation of these effects will guide the nurse and the wider multidisciplinary team in future needs and care. Tracheostomy care and management is more and more necessary in both the intensive care setting and the general ward. It is, therefore, ever more important that trained nurses are equipped with the appropriate skills, knowledge and support to meet the unique needs of each patient safely and competently. This article aims to discuss the indications for a tracheostomy and also the care and management commonly carried out, with the purpose of increasing knowledge and interest of the care of a patient with a tracheostomy.

Body Image↗
PubMed1995

Technical and practical considerations involved in operations on patients weighing more than 270 kg.

Care of the patient with superobesity requires special precautions and appropriate equipment. Recently, we performed bariatric procedures (modified very-long-limb Rouxen-Y gastric bypass) on patients weighing 355 kg and 377 kg. These procedures required preoperative preparation concerning safe means of transport of the patient, techniques of anesthesia and intraoperative exposure, provisions for postoperative recovery, and measures to assure patient comfort and hygiene postoperatively. In addition to specially designed bariatric procedures for the superobese, specialized equipment is needed to protect the health of the patient and the staff. All health care providers and especially acute care centers must have preconceived protocols to treat the superobese patient. In addition, specialized equipment is necessary to allow safe transport and support of these patients.

Adult↗
PubMed1989

Surgical correction of the acromegalic face. A one stage procedure with a team approach.

The features of acromegaly are presented with special reference to facial deformity. A one-stage procedure with careful pre-operative planning is advocated. The operating team is composed of a plastic surgeon and an oral surgeon. The frontal protrusion is corrected by osteotomy, the vertical and anteroposterior facial disproportion by bimaxillary procedures, the nasal deformity by rhinoplasty or skull bone grafting, and the macroglossia by tongue resection. This results in an improvement of the patient's psyche and frequently improvement in speech.

Acromegaly↗
PubMed1993

Percutaneous tracheostomy--an intensive care procedure.

Percutaneous tracheostomy (PCT) facilitates easy, bedside insertion of a tracheostomy tube. The percutaneous approach to tracheostomy is used in some parts of the world. This is the first report of a PCT method, in Ireland. The percutaneous technique appears to have advantages over conventional, surgical tracheostomy.

Anesthesia, General↗
PubMedDate not supplied

Dysphagia in the patient with a tracheostomy: six cases of inappropriate cuff deflation or removal.

Patients with tracheostomy tubes have altered motor and sensory functions that may decrease their swallowing efficiency. Failure to recognize disorders in deglutition may result in dangerous complications including aspiration and death. Assessment of dysphagia is especially important in the patient transferred from the intensive care unit to the ward--where resources are less abundant. We present six cases in which cuff deflation or change of tracheostomy tube were undertaken without documented swallowing assessment. In these cases each patient was found to be aspirating and required the cuff to be reinflated, or a cuffed tube to be reinstated when assessed by the multidisciplinary team. Dysphagia management in the patient with a tracheostomy should be approached from a multidisciplinary point of view so that appropriate decisions can be made regarding changes in management and the decannulation process.

Adult↗
PubMed2004

[The management of Dysphagia. Part 1: diagnostics].

Patients with chronic dysphagia are often in need of artificial nutrition; though being well balanced in terms of energy and vitamins, patients are at a high risk for the loss of resistance and body weight. Dysphagia also causes a severe drawback of the overall quality of life. This paper gives an overview of the present management of dysphagia from the point of view of otolaryngologists, head-neck-surgeons, phoniatricians, and medical speech-language-voice-pathologists. The physiology of swallowing and typical symptoms of dysphagia are first explained. Then the current most important diagnostic procedures as orofacial and laryngeal function analysis, video-endoscopy, and quantitative assessments, are discussed (part 1). This also includes considerations on bolus viscosity variation, postures, swallowing maneuvers, and sensory enhancement procedures, while actual options like botulinum toxin, passy-muir speaking valve, electromyographic biofeedback, and electrostimulation are also mentioned (part 2).

Chronic Disease↗
PubMed1993

Effects of signaling invasive procedures on a hospitalized infant's affective behaviors.

We report the effects of using a visual and auditory stimulus signaling impending painful medical procedures versus "safe" periods on the affective behavior of a hospitalized infant. The results of a reversal design suggested that the signaling procedures increased positive behaviors and decreased negative behaviors during both noninvasive and invasive caregiver events.

Adaptation, Psychological↗
PubMedDate not supplied

Standardizing adult tracheostomy tube styles: what is the clinical and cost-effective impact?

Tracheostomy tubes are made of a variety of materials, components, and styles. In a recent merger of our hospitals, we noted a large assortment of tubes available for clinicians. The different tubes resulted in complaints from staff, which included confusion, delays in obtaining preferred tubes, and inconsistent shelf stock. A multidisciplinary task force was formed to recommend standardizing the styles of tracheostomy tubes. A comparison of tracheotomy procedures, tracheostomy tube usage, and tube costs were done 6 months before and 6 months after the standardization. The number of tube styles decreased from 9 to 4; specialty extra-long tubes decreased from 3 to 2. There were no cost savings in standardizing the tracheostomy tubes.

Adult↗