An Interdisciplinary Approach to the Management of Individuals With Tracheostomy

Abstract

BACKGROUND: Study objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after ICU discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach. METHODS: This retrospective cohort study recruited all adult tracheostomy patients admitted between January 2016 and December 2018. Long-term tracheostomy patients with recurrent admissions and compromised airway and patients with neck tumors obstructing the airway were excluded. Data regarding subjects’ demographics, comorbidities, Glasgow coma score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse; respiratory therapist; speech clinician; ear, nose, and throat specialist; and rehab medicine specialist. RESULTS: Of the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 d. Predictors of long-term tracheostomy were GCS<11 (odds ratio [OR] 5.6 [95% CI 2.7-12.0]), age 6 65 y (OR 4.5 [95% CI (2.1-10.0]), comorbidities 6 2 (OR 4.0 [95% CI 1.5-11.2]), and female sex (OR 3.0 [95% CI 1.3-7.4]). The proportion of subjects with long-term tracheostomy significantly increased with the total number of predictors (Fisher exact test, P