Title

Characteristics, Resource Utilization, and Nursing Care of Patients Who Undergo Percutaneous Tracheostomy

Authors

Authors

M. L. Sole; S. Talbert; D. A. Penoyer; M. Bennett; S. Sokol;J. Wilson

Comments

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Abbreviated Journal Title

Clin. Nurse Spec.

Keywords

characteristics; outcomes; percutaneous tracheostomy; resource; utilization; PROLONGED MECHANICAL VENTILATION; CRITICALLY-ILL PATIENTS; ACUTE; RESPIRATORY-FAILURE; SURGICAL TRACHEOSTOMY; TRACHEOTOMY; METAANALYSIS; INTUBATION; OUTCOMES; Nursing

Abstract

Purpose/Objectives: Many critically ill patients require a tracheostomy when unable to be weaned from prolonged ventilator support. This study describes the characteristics, resource use, and outcomes of patients who required a tracheostomy for failure to wean from mechanical ventilation. Design: A retrospective descriptive study was conducted to analyze data from the electronic medical record and hospital databases. Setting: The setting was a tertiary care hospital with a level I trauma center. Sample: Data from 363 adult subjects who underwent a tracheostomy after prolonged mechanical ventilation during a 1-year period were obtained from hospital databases. All underwent a percutaneous procedure. The majority of subjects were male (62.8%) and white (57.9%), with a median age of 59 years. Nearly half had a trauma diagnosis. Results: Hospital mortality was low (9.9%). Ventilator days, hospital/intensive care unit lengths of stay, and costs were high. Only 7.1% of subjects were discharged directly from the hospital to home. Others were transferred to long-term acute-care hospitals, rehabilitation centers, skilled nursing facilities, and other hospitals. Those who had the tracheostomy done prior to 10 days of ventilation had better outcomes; however, these same subjects had lower acuity scores. Within 1 day of the procedure, ventilator settings were reduced, airway pressures were lower, and level of sedation was improved. Conclusions: Patients requiring a tracheostomy incur high resource use, and although the majority was transferred to other facilities, the number discharged directly home was low. Improved physiological parameters and reduced ventilator settings following the tracheostomy facilitated weaning from ventilation. Implications: Knowledge of characteristics and outcomes may assist in identifying interventions to reduce the need for tracheostomy or improve outcomes. In particular, the clinical nurse specialist can lead team initiatives to promote weaning prior rather than performing a tracheostomy as well as interventions postprocedure to improve discharge outcomes.

Journal Title

Clinical Nurse Specialist

Volume

28

Issue/Number

5

Publication Date

1-1-2014

Document Type

Article

Language

English

First Page

288

Last Page

295

WOS Identifier

WOS:000340814400010

ISSN

0887-6274

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