The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Jhaymie Cappiello, Lindsey Kreisher, Janice Thalman; Duke University Hospital, Durham, NC

Background: An increased risk of pneumonia, swallow dysfunction, speech difficulties, and post hospital placement difficulties are associated with the prolonged mechanical ventilation patient that require tracheostomy. Monitoring care practice for this group of patients is not standardized. Recent studies that have addressed tracheostomy care teams have reported on total cannulation days, total mechanical ventilation days, or cannulation days post ICU discharge. A tracheostomy care team has recently been created at our institution and protocols are being designed with a focus on weaning to decannulation. To develop appropriate outcome measures for this team, we retrospectively reviewed the current practice of tracheostomy patients at our institution. We were particularly interested in tracheostomy days post ventilator liberation to decannulation (TDPV). Method: A retrospective electronic review of adult patients who were mechanically ventilated, required a tracheostomy, and were successfully decannulated was performed for 15 consecutive months (January 2009-Mar 2010). As our focus was on prolonged mechanically ventilated patients for medical reasons, patients on the cardiothoracic and otolaryngology services were excluded. Data obtained included; date of mechanical ventilation initiation, tracheostomy date, date of liberation from mechanical ventilation, and date of decannulation. Mean values were calculated for mechanical ventilation days to tracheostomy (MVTT), mechanical ventilation days post tracheostomy (MVPT), mechanical ventilation days (MVD), and tracheostomy days post ventilator (TDPV). Results: 58 patients were studied. Demographic data revealed: 35 male, 23 female, with a mean age (+/- SD) of 45 +/- 16 years. Forty three patients came from the surgical ICU, 15 from the medical ICU. Mean (+/- SD) MVTT = 9.6 +/-5.6, MVPT = 8.6 +/-7.2, MVD = 19 +/- 8.7, and TDPV = 12.9 +/- 6.9. Conclusion: The development of standard reporting values may prove useful to evaluate current practice and realize practice variations. The routine monitoring of TDPV may serve as a particularly useful benchmark for monitoring and providing support for standardizing tracheostomy management. Sponsored Research - None