25 Questions
What is the focus of the AARC Clinical Practice Guideline?
Enhancing the care of patients with tracheostomy
What motivated the renewed interest in the management of patients with tracheostomy?
Recognition of the need to decrease morbidity and mortality
What were the key outcomes addressed in the development of clinical practice guidelines?
Time to decannulation, length of stay, tracheostomy-related cost
What is the primary goal of the systematic review conducted for the development of recommendations?
Facilitate the development of recommendations relevant to the care of adult patients with tracheostomy
Why is there a renewed interest in the management of patients with tracheostomy in recent years?
To optimize the value of the procedure
What databases were used for the literature search?
PubMed, CINAHL via EBSCOhost, and Scopus.com
How many articles remained after removing duplicates?
1,117
What method was used to develop recommendations in the systematic review?
Modification of the RAND/UCLA Appropriateness Method
What types of interventions were included in the pretest/posttest TRAPU bundle interventions?
Electronic postoperative order set, trach tracking system, RT-driven decannulation protocol, and formal rounding process
What did observational studies show about tracheostomy care bundles?
Higher rates of decannulation, oral diet tolerance, and lower TRAPU events
What type of study design was utilized in the research?
Prospective observational design with historic control
What was the impact of implementing a tracheostomy care team?
Marked improvement in the initial referral times to speech-language pathology
What were the outcomes of the TRAMS (tracheostomy review and management service)?
Significantly improved outcomes for spinal cord injury patients
What was the impact of the implementation of a weekly tracheostomy multidisciplinary team (TMDT) ward round?
Increased compliance with the tracheostomy care bundle
What was the impact of the specialist tracheostomy care nurse team implementation?
Decreased complication rates and ICU readmissions
What was the impact of the tracheostomy team approach on mean hospital length of stay for survivors?
It reduced from 50 days to 27 days
What was the impact of the team approach on adverse events?
There was no statistically significant reduction
Which protocol consistently decreased the time to decannulation without increasing adverse events?
Decannulation protocol
What was the impact of the multidisciplinary protocol on dysphagic patients?
It was associated with earlier decannulation
What is a key feature of care bundles mentioned in the study?
They consist of 3-5 components
What is the impact of using tracheostomy bundles evaluated and approved by experienced individuals?
Decrease time to decannulation and tracheostomy-related adverse events
What is the impact of adding a multidisciplinary tracheostomy team?
Improve time to decannulation, length of stay, tracheostomy-related adverse events, and increase speaking valve use
What is the impact of using a weaning/decannulation protocol?
Improves time to decannulation
What percentage of adult patients requiring mechanical ventilation received a tracheostomy between 1993 and 2012?
9.1%
What percentage of tracheostomy patients suffer adverse events?
7%
Study Notes
Recommendations for Tracheostomy Management in Acute Care Setting
- Tracheostomy bundles evaluated and approved by experienced individuals can decrease time to decannulation, tracheostomy-related adverse events, and improve tolerance of oral diet.
- Addition of a multidisciplinary tracheostomy team can improve time to decannulation, length of stay, tracheostomy-related adverse events, and increase speaking valve use.
- Use of a weaning/decannulation protocol improves time to decannulation.
- Tracheostomy is common in critically ill patients, with 9.1% of adult patients requiring mechanical ventilation receiving a tracheostomy between 1993 and 2012.
- Patients with tracheostomy have higher morbidity and longer hospital stays, leading to higher healthcare costs.
- Patients with tracheostomy have higher mortality rates and poorer outcomes compared to those without tracheostomy.
- 7% of tracheostomy patients suffer adverse events, and 19.7% do not survive to discharge.
- Even patients surviving the first year after tracheostomy have poor outcomes with multiple readmissions to acute care hospitals.
- Effective management of tracheostomy patients is necessary to prevent morbidity, mortality, and reduce healthcare costs.
- Recommendations were developed through a systematic review of peer-reviewed literature by a committee selected by the American Association for Respiratory Care (AARC) based on their experience and commitment.
- The committee developed clinical practice guidelines related to the impact of tracheostomy bundles, tracheostomy teams, and protocol-directed care on time to decannulation, length of stay, tracheostomy-related cost, and adverse events in tracheostomized adult patients in the acute care setting.
- Committee members received no remuneration for their participation in the process, though their expenses for the face-to-face meeting were covered by the AARC.
Test your knowledge of tracheostomy management in acute care settings with this quiz. Explore the impact of tracheostomy bundles, multidisciplinary teams, and protocols on patient outcomes, length of stay, and healthcare costs. Learn about the recommendations developed by the American Association for Respiratory Care (AARC) through a systematic review of peer-reviewed literature.
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