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. 2019 Jul;1(7):e0022.
doi: 10.1097/CCE.0000000000000022.

Improving Tracheostomy Decannulation Rate In Trauma Patients

Michael S Farrell  1 , Thomas M Gillin  1 , John S Emberger  1 , John Getchell  1 , Richard J Caplan  1 , Mark D Cipolle  1 , Kevin M Bradley  1
Affiliations

Improving Tracheostomy Decannulation Rate In Trauma Patients

Michael S Farrell et al. Crit Care Explor. 2019 Jul.

Abstract

Objective: Identify the effect of a multidisciplinary tracheostomy decannulation protocol (TDP) in the trauma population.

Design: Single center retrospective review.

Setting: American College of Surgeons Level 1 Trauma Center; large academic associated community hospital.

Patients: Adult trauma patients who required a tracheostomy.

Interventions: A TDP empowering respiratory therapists to move patients towards tracheostomy decannulation (TD).

Measurements: TD rate, time to TD, length of stay, reintubation and recannulation rates.

Main results: A total of 252 patients met inclusion criteria during the study period with 134 presenting after the TDP was available. Since the TDP was implemented, patients managed by the TDP had a 50% higher chance of TD during the hospital stay (p<0.001). The time to TD was 1 day shorter with the TDP (p=0.54). There was no difference in time to discharge after ventilator liberation (p=0.91) or in discharge disposition (p=0.66). When comparing all patients, the development of a TDP, regardless if a patient was managed by the TDP, resulted in an 18% higher chance of TD (p=0.003). Time to TD was 5 days shorter in the post intervention period (p=0.07). There was no difference in discharge disposition (p=0.88) but the time to discharge after ventilator liberation was shorter post protocol initiation (p=0.04).

Conclusions: In a trauma population, implementation of a TDP significantly improves TD rates during the same hospital stay. A larger population will be required to identify patient predictive factors for earlier successful TD.

Keywords: Airway; Mechanical Ventilation; Respiratory Therapist; Tracheostomy; Tracheostomy Decannulation; Trauma.

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Figures

Figure 1.
Figure 1.
Outline of the tracheostomy decannulation protocol.
Figure 2.
Figure 2.
Patient count per treatment group.
See this image and copyright information in PMC

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