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Management of Tracheostomy: A Survey of Dutch Intensive Care Units

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Abstract:

OBJECTIVE: To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities. METHODS: We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have > 5 beds suitable for mechanical ventilation. The survey asked for demographic information about the hospital and ICU setting, and for information and opinions about tracheostomy management in the ICU and step-down facilities, and the use of tracheostomy-management guidelines. RESULTS: Forty-four of the 69 ICUs responded. Sixty-four percent of the respondent ICUs only deflate the cuff when the patient is breathing spontaneously, without assistance from the ventilator. Fifty-nine percent do not routinely change the tracheostomy tube. Almost half use inner cannulas in tracheostomy tubes. Overall, intensivists were most often involved in the follow-up of discharged tracheostomized patients. In the nonacademic hospitals, specialized ICU nurses were more often involved (P = .05). Sixty-four percent indicated they have no guideline for managing discharged tracheostomized patients. There was a diversity of opinion (median visual-analog-scale score 5.0, 95% confidence interval 3.0 to 8.0) on whether the tracheostomy tube should be removed “at once” or after “down-sizing.” CONCLUSIONS: There were large differences in tracheostomy management among Dutch ICUs. ICU and post-ICU tracheostomy-management guidelines are lacking and needed.

Keywords: CUFF; DECANNULATION; INNER CANNULA; MECHANICAL VENTILATION; NETHERLANDS; SURVEY; TRACHEOSTOMY; TRACHEOSTOMY TUBE

Document Type: Research Article

Affiliations: 1: Department of Anesthesiology, Academic Medical Center, G3-228, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;, Email: d.p.veelo@amc.uva.nl 2: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, HERMES (Harmonised Education in Respiratory Medicine for European Specialists) Critical Care Group, Amsterdam, The Netherlands 3: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 4: Department of Intensive Care Medicine, Gelre Hospital, Lukas, Apeldoorn, The Netherlands

Publication date: December 1, 2008

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