The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

THE SAFETY OF ICU PATIENTS DISCHARGED TO THE MEDICAL-SURGICAL WARDS WITH TRACHEOSTOMIES: THE BENEFITS OF A COMPREHENSIVE TRACHEOSTOMY CARE PROTOCOL

Cathy Biros, Luanne Hills, Donald Bellerive, Scott Kopec; Respiratory Care, U Mass. Memorial Medical Center, Worcester, MA

BACKGROUND: Patients with tracheostomies who are weaned from mechanical ventilation but no longer require ICU care are frequently transferred to non-ICU wards. Studies have suggested that these patients have mortality rates as high as 26%, more than twice that of patients who are decannulated in the ICU prior to transfer. The mortality rate appears higher in patients with obesity and lower GCS. We attempted to determine if a comprehensive, multi-disciplinary management policy aimed at caring for patients with tracheostomies on the Med/Surg wards would result in a lower mortality rate, and less respiratory and tracheostomy-related complications. METHODS: All patients transferred out of the ICU to the Med/Surg wards with tracheostomies were enrolled in the protocol. All patients were assessed by the floor respiratory therapist within 8 hours of transfer. The RT assured that each patient was on humidified oxygen, had the proper spare tracheostomy tube, suction equipment, ambu bag and other bedside equipment. The Rt educated the floor staff on proper suctioning, patient monitoring as well as general tracheostomy care. In addition, the RT rounded on the patient every 12 hours with the outcomes recorded as well as other parameters such as initial diagnosis, BMI, GCS, and the patients ability to call for assisstance. RESULTS: 52 consecutive patients with tracheostomies were followed after they were transferred to the Med/Surg wards at a major University tertiary care center. Indications for initial ICU admission included major trauma, neurological injuries, septic shock, and respiratory failure. Patients spent an average of 6.4 days off mechanical ventilation before transfer and were felt not to require suctioning more than every 4 hours. Average BMI was 28.5, average GCS on transfer was 11.9. Two patients required re-admission to the ICU; 1 due to mucous plugging and respiratory failure, and 1 due to an acute abdomen. There were no mortalities. Morbid obesity, mental status, suctioning frequency, nor the ability to communicate was considered a risk factor for death or the need for re-admission into the ICU. CONCLUSION: Patients transferred from an ICU to a ward with a tracheostomy can be safely managed if a comprehensive, multidisciplinary tracheostomy care protocol is actively employed. Factors such as morbid obsity or low GCS do not appear to increase mortality or rates of complications. Sponsored Research - None