Authors

Ana Wensell Fernández1, Cristina Telenti Rodríguez2

Position

¹Máster en Educación Física y Salud. Enfermera. Unidad de Cuidados Intensivos Polivalente del Hospital Universitario Central de Asturias (HUCA). Asturias²Máster propio en técnicas osteopáticas del aparato locomotor. Enfermera y fisioterapeuta. Unidades de Hospitalización del Hospital Universitario Central de Asturias (HUCA). Asturias

Contact address

Ana Wensell Fernández. Hospital Universitario Central de Asturias. Avda. Roma, s/n. 33011 Oviedo (Asturias).

Contact email: anawesfer@hotmail.com

Abstract

Objective: to analyze the guidelines for action and management in clinical practice for patients admitted at an Intensive Care Unit (ICU), who have undergone tracheotomy, to understand their complications and evolution.
Method: a retrospective observational study on all patients admitted at a multipurpose ICU from March, 15th, 2017 to March, 15th, 2018, who underwent a tracheotomy. Data were extracted from the computerized clinical record. The demographical and clinical variables of the patient were studied, as well as those associated with tracheotomy. Descriptive and inferential analysis was used. A value of p< 0.05 was considered significant.
Results: forty-eight (48) patients were included, with a mean age (standard deviation) of 61.7 (14.9) years; 34 (71%) were male. At admission, the primary diagnosis was neurological: 27 (56%). Nine (19%) patients died at the ICU. Forty-nine (49) tracheotomies were conducted, 35 (71%) were surgical; 105 trach tubes were used. Twenty-seven (27) complications were recorded; the most usual were of late onset (44%), and by type, stoma infection (26%). Decannulation was significantly associated with swallowing (p= 0.005) and trach tube sealing (p= 0.001). Only the management of the endotracheal tube cuff was significantly associated with the development of complications (p= 0.029).
Conclusions: tracheotomy can be considered a safe practice. There is limited evidence and variability in clinical practice in terms of care for patients with tracheotomy. The use of protocols including aspects such as the management of the endotracheal tube cuff, swallowing or phonation, among others, could increase the quality and safety of care for these patients.

Keywords:

Tracheotomy; airway management; mechanic ventilation; protocols; Intensive Care Units

Versión en Español

Título:

Manejo clínico y complicaciones de pacientes traqueotomizados en cuidados intensivos