Document Detail

Tracheostomy protocol: experience with development and potential utility.
MedLine Citation:
PMID:  18496369     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To examine the feasibility and potential utility of a tracheostomy protocol based on a standardized approach to ventilator weaning. DESIGN: Prospective, observational data collection. SETTING: Academic medical center. PATIENTS: Surgical intensive care unit patients requiring mechanical ventilatory support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Tracheostomy practice in 200 patients was analyzed in relation to spontaneous breathing trial (SBT) weaning. Decision for, and performance of, tracheostomy occurred (median [interquartile range]) 5.0 (3.75-8.0) and 7.0 (5.0-10.0) days following initiation of mechanical ventilation, respectively. Duration of mechanical ventilation was greater in tracheostomy compared with nontracheostomy patients (15.0 [11.0-19.0] vs. 6.0 [4.0-8.0], p < .001). For patients requiring ventilatory support for > or = 20 days, 100% of patients were maintained via tracheostomy. A protocol based on weaning performance, which included technical considerations, was developed. Individuals who failed preliminary weaning assessment or SBT for 3 successive days following 5 days (nonreintubated patients) or 3 days (reintubated patients) of ventilatory support met tracheostomy criteria. The protocol was implemented on a pilot basis in 125 individuals. Of the 55 (44.0%) patients undergoing tracheostomy, 25 (45.5%) did so consistent with criteria. Eighteen patients (32.7%) underwent tracheostomy before the time interval of data collection targeting weaning protocol performance, and 12 patients (21.8%) passed SBT on one or more occasions, were not extubated, and proceeded to tracheostomy. CONCLUSIONS: A standardized approach in which the decision for tracheostomy is based on objective measures of weaning performance may be a means of using this procedure more consistently and effectively.
Bradley D Freeman; Carie Kennedy; T Elizabeth Robertson; Craig M Coopersmith; Marilyn Schallom; Carrie Sona; Lisa Cracchiolo; Douglas J E Schuerer; Walter A Boyle; Timothy G Buchman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  36     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1742-8     Citation Subset:  AIM; IM    
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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MeSH Terms
Academic Medical Centers
Benchmarking / standards
Critical Pathways / standards*
Decision Support Techniques
Intensive Care / standards*
Middle Aged
Pilot Projects
Prospective Studies
Quality Assurance, Health Care / standards
Tracheostomy / standards*
Ventilator Weaning / standards*
Comment In:
Crit Care Med. 2008 Jun;36(6):1959-60   [PMID:  18520651 ]

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