Tracheostomy care in 2015: Are we on the right trach?

Development of the Tracheostomy Well-Being Score in critically ill patients

PURPOSE

Little attention has been given to understanding the experiences and perceptions of tracheostomized patients. This study aimed to measure the impact of tracheostomy on well-being in critically ill patients with the development of the Tracheostomy Well-Being Score (TWBS).

METHODS

This is a prospective, monocentric, observational study including critically ill patients with a tracheostomy without delirium. A 25-item questionnaire with items from six categories (respiration, coughing, pain, speaking, swallowing, and comfort) was used to select the 12 best items (two per category) to form the TWBS score after testing on two consecutive days. Item selection secured (1) that there were no skewed response distributions, (2) high stability from day 1 to day 2, and (3) high prototypicality for the category in terms of item-total correlation.

RESULTS

A total of 63 patients with a mean age of 56 years were included. The 12 items of the TWBS were characterized by a high retest reliability (τ = 0.67-0.93) and acceptable internal consistency. The overlap with the clinician rating was low, suggesting that acquiring self-report data is strongly warranted.

CONCLUSION

With the TWBS, an instrument is available for the assessment of the subjective effects a tracheostomy has on in critically ill patients. The score potentially offers a chance to increase well-being of these patients. Additionally, this score could also increase their quality of life by improving tracheostomy and weaning management.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register Identifier DRKS00022073 (2020/06/02).

X-Ray and CT Scan Based Prediction of Best Fit Tracheostomy Tube-A Pilot Study

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients’ appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r² = 0.135), carina (r² = 0.128), midpoint of larynx to carina (r² = 0.146), bronchial diameter at the left mainstem (r² = 0.323), and intrathoracic tracheal length (r² = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients’ airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing.

Coronavirus disease 2019 communication: novel sign language system to aid surgical tracheostomy whilst wearing a respirator

BACKGROUND

The coronavirus disease 2019 pandemic has necessitated rapid adaptations to all levels of clinical practice. Recently produced guidelines have suggested additional considerations for tracheostomy and advocated full personal protective equipment, including filtering facepiece code 3 masks. Air seal with filtering facepiece code 3 masks is often challenging, and full-face respirators and powered air-purifying respirators with hoods need to be employed. The infection prevention benefits of this equipment are accompanied by potential issues in communication.

OBJECTIVE

In an attempt to minimise surgical error through miscommunication, the authors sought to introduce a simple sign language system that could be used as an adjunct during surgery.

RESULTS

Following evaluation of pre-existing sign language platforms and consideration of multiple surgical factors, 14 bespoke hand signals were ultimately proposed.

CONCLUSION

Whilst this novel sign language system aims to bridge the communicative gap created by additional personal protective equipment, further development and validation of the proposed tool might be beneficial.