Management of Tracheostomy: A Survey of Dutch Intensive Care Units

Respir Care. 2008 Dec;53(12):1709-15.

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 > or = 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.

Publication types

  • Multicenter Study

MeSH terms

  • Attitude of Health Personnel
  • Clinical Protocols
  • Critical Care / organization & administration*
  • Critical Care / statistics & numerical data
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Netherlands
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Respiration, Artificial
  • Tracheostomy*