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

    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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