BACKGROUND: A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward. METHODS: This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team. RESULTS: There were 32 patients in the preservice group and 54 patients in the postservice group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p < 0.001) after creation of the team. Furthermore, there appeared to be a decreased time to first tube downsizing (26.0 to 9.4 d) and decreased time to decannulation (50.4 to 28.4 d), although this did not reach statistical significance owing to our small sample size. CONCLUSION: Standardized care provided by a specialized multidisciplinary tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve.
Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos
PASINI, Renata Lenize; FERNANDES, Yvens Barbosa; ARAUJO, Sebastião e SOARES, Silvia Maria de Toledo Piza.
Rev. bras. ter. intensiva [online]. 2007, vol.19, n.2, pp. 176-181.
JUSTIFICATIVA E OBJETIVOS: Atualmente, ainda é questionável se a traqueostomia precoce (TP) pode influenciar no desmame ventilatório ou no tempo de internação hospitalar de pacientes com traumatismo cranioencefálico (TCE). O objetivo primário deste estudo foi verificar se a TP influencia o tempo de ventilação mecânica (VM) em pacientes com TCE grave. MÉTODO: Estudo prospectivo, observacional, incluindo 33 pacientes com pontuação admissional na escala de coma de Glasgow (ECG) < 10, analisados segundo o momento de realização traqueostomia, após a intubação traqueal (precoce: t < 6 dias; intermediária: t = 7 a 11 dias; tardia: t > 12 dias) e o desmame ventilatório. RESULTADOS: O tempo total de VM foi menor no grupo TP (n = 10; p < 0,0001). No grupo TP, a menor pontuação na ECG (média de 5,3 ± 2,5) esteve negativamente correlacionada com o tempo de internação hospitalar (p = 0,02). CONCLUSÕES: A traqueostomia precoce pode reduzir os tempos de ventilação mecânica, mas não influencia o tempo de internação hospitalar em pacientes com traumatismo cranioencefálico grave.
Palavras-chave : desmame; traqueostomia; traumatismo cranioencefálico; ventilação mecânica.
Mark A. Dettelbach, Roxann D. Gross MA, Jeanne Mahlmann, David E. Eibling
Head & neck, 2006 – Wiley Online Library
Objective. To assess potential benefit of a Passy-Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy.
Background. Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one-way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration.
Methods. Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube.
Results. Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies.
Conclusion. This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.
Barros, Ana Paula Brandão; Portas, Juliana Godoy; Queija, Débora dos Santos.
Rev. bras. cir. cabeça pescoço;38(3):202-207, jul.-set. 2009. ilus.
Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.