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Surveillance and management practices in tracheotomy patients

Authors

  • Hannah Zhu MS (Hons),

    1. School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, United Kingdom
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    • Drs. Zhu and Das contributed equally to this article.

  • Preety Das MS (Hons),

    1. School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, United Kingdom
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    • Drs. Zhu and Das contributed equally to this article.

  • Jean Brereton MBA,

    1. American Academy of Otolaryngology–Head and Neck Surgery, Washington, DC
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  • David Roberson MD,

    1. Department of Otolaryngology, Children's Hospital Boston, Program for Patient Safety and Quality, Boston, Massachusetts, and Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
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  • Rahul K. Shah MD

    Corresponding author
    1. Division of Otolaryngology, Children's National Medical Center, Washington, DC
    • Division of Otolaryngology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010
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  • Editor's Note: This Manuscript was accepted for publication August 24, 2011.

Abstract

Objectives/Hypothesis:

To ascertain the surveillance and management practices for tracheotomy patients.

Study Design:

Survey of tracheotomy management.

Methods:

An electronically distributed 26-question survey was distributed under the auspices of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Results:

There were 478 responses. The mean number of years in practice was 21.2 years (standard deviation [SD], 11.0 years). Sixty-five percent of respondents perform mainly adult tracheotomy. There is variation in surveillance patterns of immediate, postoperative, intermediate, and long-term surveillance. On average, respondents follow a fresh tracheotomy daily for about 6 days, monthly for about 3 months, and long-term surveillance every 4 months on average. Almost all respondents perform long-term surveillance during routine tracheotomy changes; 61.4% perform this surveillance with an endoscope, and a minority rely on history and examination. The mean frequency of tracheotomy tube changes was 2 months (SD, 2.2 months; median, 1.1 month; range, 0.06–12 months). Two hundred sixty-one respondents have or have used a decannulation algorithm. The vast majority, 96.2%, are comfortable with their current management practices. Over half of the respondents perceive value in a clinical practice guideline to help them with standardizing care, and 80% of respondents feel that it would assist other specialties in the care and surveillance of tracheotomy patients.

Conclusions:

There is marked variability in the surveillance and management of tracheotomy patients. There exists opportunity to improve care through standardization of surveillance and management of these patients. Laryngoscope, 122:46–50, 2012

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