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2.
Artigo em Inglês | MEDLINE | ID: mdl-31836355

RESUMO

INTRODUCTION: Pediatric patients who develop acute kidney injury (AKI) while hospitalized have longer hospital stays, increased morbidity and mortality, and are at an increased risk for developing chronic kidney disease. Early recognition of AKI is becoming a major clinical focus. There is little research focusing on nursing interventions that may affect a pediatric patient's risk for developing AKI. The purpose of this review is to summarize reported predictors of AKI to improve its early recognition and treatment among hospitalized pediatric patients. METHODS: A review of research was conducted to further identify risk factors of AKI among noncritically ill hospitalized pediatric patients. RESULTS: The current literature demonstrated inconsistent findings in early recognition of AKI among hospitalized pediatric patients. DISCUSSION: Interventions for early recognition and treatment of AKI should consider other variables, such as previous history of AKI and fluid status as risk factors, warranting additional research.

3.
Am J Crit Care ; 28(6): 441-450, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31676519

RESUMO

OBJECTIVE: To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes. METHODS: PubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, "Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?" Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence. Data were abstracted, cross-checked for accuracy, and synthesized. RESULTS: Of the 160 studies identified, 13 met inclusion criteria, including 6 clinical studies (104 patients), 6 case reports (13 patients), and 1 nationwide clinician survey. The primary indications for a tracheostomy were chronic ventilator dependence (83%) and airway protection (17%). Indications for fenestrated tracheostomy included inaudible phonation and poor voice intelligibility. Patients with fenestrated tubes achieved robust voice outcomes. Complications included granulation tissue (6 patients [5%]), malpositioning (1 patient [0.9%]), decreased oxygen saturation (3 patients [2.6%]), increased blood pressure (1 patient [0.9%]), increased peak pressures (2 patients [1.7%]), and air leakage (1 patient [0.9%]); subcutaneous emphysema also occurred frequently. Patient-reported symptoms included shortness of breath (4 patients [3.4%]), anxiety (3 patients [2.6%]), and chest discomfort (1 patient [0.9%]). CONCLUSIONS: Fenestrated devices afford benefits for speech and decannulation but carry risks of granulation, aberrant airflow, and acclimation challenges. Findings highlight the need for continued innovation, education, and quality improvement around the use of fenestrated devices.

4.
J Nurs Adm ; 49(12): 617-623, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31725520

RESUMO

In healthcare, timely communication of critical information is imperative among workforce members. Nurse leaders struggle with how to reach clinical staff effectively when informing them of program updates, practice changes, or available resources. This article provides a review of the marketing and communication literature sharing best practices for improving visibility and program uptake for infrastructure supporting the conduct of inquiry projects among hospital employees using an evidence-based practice approach.


Assuntos
Comunicação , Enfermagem Baseada em Evidências/organização & administração , Disseminação de Informação/métodos , Pesquisa em Enfermagem/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Laryngoscope ; 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31385620

RESUMO

OBJECTIVE: The primary objective of our study was to determine the quality of life (QOL) using a talking tracheostomy tube. METHODS: Randomized clinical trial (NCT2018562). Adult intensive care unit patients who were mechanically ventilated, awake, alert, attempting to communicate, English-speaking, and could not tolerate one-way speaking valve were included. Intervention comprised a Blue Line Ultra Suctionaid (BLUSA) talking tracheostomy tube (Smiths Medical, Dublin, OH, US). Outcome measures included QOL scores measured using Quality of Life in Mechanically Ventilated Patients (QOL-MV) and Voice-Related Quality of Life (V-RQOL), Speech Intelligibility Test (SIT) scores, independence, and satisfaction. RESULTS: The change in V-RQOL scores from pre- to postintervention was higher among patients using a BLUSA (Smiths Medical) compared to those who did not (P = 0.001). The QOL-MV scores from pre- to postintervention were significantly higher among patients who used a BLUSA (Smiths Medical) compared to patients who did not use BLUSA (Smiths Medical) or a one-way speaking valve (P = 0.04). SIT scores decreased by 6.4 points for each 1-point increase in their Sequential Organ Failure Assessment scores (P = 0.04). The overall QOL-MV scores correlated moderately with the overall V-RQOL scores (correlation coefficient = 0.59). Cronbach alpha score for overall QOL-MV was 0.71. Seventy-three percent of the 22 intervention patients reported the ability to use the BLUSA (Smiths Medical) with some level of independence, whereas 41% reported some level of satisfaction with the use of BLUSA (Smiths Medical). The lengths of stay was longer in the intervention group. CONCLUSION: Our study suggests that BLUSA (Smiths Medical) talking tracheostomy tube improves patient-reported QOL in mechanically ventilated patients with a tracheostomy who cannot tolerate cuff deflation. LEVEL OF EVIDENCE: I Laryngoscope, 2019.

6.
Am J Speech Lang Pathol ; 28(3): 1019-1028, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318610

RESUMO

Purpose The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.

7.
Hosp Pediatr ; 9(6): 468-475, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088891

RESUMO

Rapid response teams have become necessary components of patient care within the hospital community, including for airway management. Pediatric patients with an increased risk of having a difficult airway emergency can often be predicted on the basis of clinical scenarios and medical history. This predictability has led to the creation of airway consultation services designed to develop airway management plans for patients experiencing respiratory distress and who are at risk for having a difficult airway requiring advanced airway management. In addition, evolving technology has facilitated airway management outside of the operating suite. Training and continuing education on the use of these tools for airway management is imperative for clinicians responding to airway emergencies. We describe the comprehensive multidisciplinary, multicomponent Pediatric Difficult Airway Program we created that addresses each component identified above: the Pediatric Difficult Airway Response Team (PDART), the Pediatric Difficult Airway Consult Service, and the pediatric educational airway program. Approximately 41% of our PDART emergency calls occurred in the evening hours, requiring a specialized team ready to respond throughout the day and night. A multitude of devices were used during the calls, obviating the need for formal education and hands-on experience with these devices. Lastly, we observed that the majority of PDART calls occurred in patients who either were previously designated as having a difficult airway and/or had anatomic variations that suggest challenges during airway management. By instituting the Pediatric Difficult Airway Consult Service, we have decreased emergent Difficult Airway Response Team calls with the ultimate goal of first-attempt intubation success.

8.
Am J Crit Care ; 28(1): 56-63, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30600228

RESUMO

BACKGROUND: Readmission for ventilator support in tracheostomy patients with primary brain injury is often attributed to failure of airway protection and aspiration pneumonia. Data regarding the incidence of intensive care unit readmissions and associated factors in these patients are limited. OBJECTIVES: To determine the factors associated with intensive care unit readmission among tracheostomy patients with primary brain injury, as compared with tracheostomy patients without primary brain injury. METHODS: Prospectively acquired data from an ongoing tracheostomy registry at an academic health center were reviewed retrospectively. A total of 164 patients more than 18 years of age who received an elective tracheostomy and had at least 1 readmission to the intensive care unit between 2007 and 2013 were included. RESULTS: The incidence of mechanical ventilation resumption and readmission was significantly higher in patients with than without primary brain injury (P = .005). Patients requiring tracheostomy for airway protection were at a higher risk for atelectasis (odds ratio, 8.23; P = .05). In patients with primary brain injury, a higher Glasgow Coma Scale score was associated with a lower risk for atelectasis (odds ratio, 0.84; P = .04). Mean (SD) Glasgow Coma Scale score was higher in patients without primary brain injury (10.64 [3.98]) than in patients with primary brain injury (8.62 [4.57]; P = .006). CONCLUSIONS: Tracheostomy patients with primary brain injury may have central nervous system-mediated respiratory compromise associated with reduced Glasgow Coma Scale score, increased atelectasis, and shorter duration of ventilator dependency.

9.
Otolaryngol Clin North Am ; 52(1): 135-147, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30297183

RESUMO

There have been reports of successful quality-improvement initiatives surrounding tracheostomy care for more than a decade, but widespread adoption of best practices has not been universal. Five key drivers have been found to improve the quality of care for tracheostomy patients: multidisciplinary synchronous ward rounds, standardization of care protocols, appropriate interdisciplinary education and staff allocation, patient and family involvement, and use of data to drive improvement. The Global Tracheostomy Collaborative is a quality-improvement collaborative dedicated to improving the care of tracheostomy patients worldwide through communication, dissemination, and implementation of proven strategies based on these 5 key drivers.


Assuntos
Comunicação Interdisciplinar , Assistência Perioperatória/normas , Melhoria de Qualidade/organização & administração , Traqueostomia/efeitos adversos , Humanos , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Assistência Perioperatória/métodos
10.
J Intensive Care Med ; 34(10): 835-843, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28675111

RESUMO

BACKGROUND: In patients with severe neurologic conditions, percutaneous endoscopic gastrostomy (PEG) is typically performed either alone or with a tracheostomy. The characteristics and outcomes of patients receiving PEG concomitantly with a tracheostomy (CTPEG) and those receiving delayed PEG (DPEG) after a tracheostomy were compared. METHODS: Retrospective cohort study in a 24-bed neuroscience critical care unit (NCCU) at a tertiary care hospital. Consecutive patients admitted to the NCCU from April 2007 to July 2013 who underwent percutaneous tracheostomy and gastrostomy by the percutaneous tracheostomy team were included and grouped according to the timing of PEG placement: CTPEG versus DPEG. RESULTS: Of the 290 patients, 234 (81%) received CTPEG. Demographic and clinical characteristics were similar among the 2 groups except for a lower median (interquartile range [IQR]) body mass index (BMI; 27 [22.67-31.60] versus 30.8 [24.55-40.06], P = .017) and lower rate of acute respiratory distress syndrome (3.85% vs 10.71%, P = .048) in the CTPEG cohort. Furthermore, 59% of CTPEG cohort were neurology patients while 63% of DPEG were neurosurgery patients, P = .004. Primary outcomes showed shorter mean NCCU length of stay (LOS; 25 [12] vs 33 [17] days, P < .001) and median hospital LOS (32 [25-43] vs 37 [31-56] days, P = .002) for the CTPEG cohort. Secondary outcomes showed higher predischarge prealbumin levels (15.6 [7.75] vs 11.58 [5.41], P = .021) and lower median overall hospital cost (US$123 860.20 [US$99 024-US$168 713.40] vs US$159 633.50 [US$121 312-US$240 213.10], P = .0003) in the CTPEG group. Anatomic contraindications were the most common reason for DPEG (30%). CONCLUSIONS: Among institutions with a tracheostomy team, the practice of tracheostomy with concomitant PEG placement may be considered as feasible as delayed PEG in carefully selected neurocritically ill patients with possible advantages of overall shorter NCCU and hospital LOS, higher predischarge prealbumin, and lower hospital costs. These findings may aid in decisions regarding the timing of PEG placement in the NCCU. Further prospective studies are warranted.

11.
Laryngoscope ; 129(6): 1360-1367, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30588625

RESUMO

OBJECTIVE: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. METHODS: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. RESULTS: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. CONCLUSION: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1360-1367, 2019.


Assuntos
Manuseio das Vias Aéreas/normas , Angioedema/terapia , Intubação Intratraqueal/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Melhoria de Qualidade , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Angioedema/patologia , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Orofaringe/patologia , Estudos Prospectivos , Estudos Retrospectivos , Centros de Atenção Terciária
12.
Crit Care Med ; 46(12): 2010-2017, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30096101

RESUMO

OBJECTIVES: To systematically review the symptoms and types of laryngeal injuries resulting from endotracheal intubation in mechanically ventilated patients in the ICU. DATA SOURCES: PubMed, Embase, CINAHL, and Cochrane Library from database inception to September 2017. STUDY SELECTION: Studies of adult patients who were endotracheally intubated with mechanical ventilation in the ICU and completed postextubation laryngeal examinations with either direct or indirect visualization. DATA EXTRACTION: Independent, double-data extraction and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias assessment followed the Cochrane Collaboration's criteria. DATA SYNTHESIS: Nine studies (seven cohorts, two cross-sectional) representing 775 patients met eligibility criteria. The mean (SD; 95% CI) duration of intubation was 8.2 days (6.0 d; 7.7-8.7 d). A high prevalence (83%) of laryngeal injury was found. Many of these were mild injuries, although moderate to severe injuries occurred in 13-31% of patients across studies. The most frequently occurring clinical symptoms reported post extubation were dysphonia (76%), pain (76%), hoarseness (63%), and dysphagia (49%) across studies. CONCLUSIONS: Laryngeal injury from intubation is common in the ICU setting. Guidelines for laryngeal assessment and postextubation surveillance do not exist. A systematic approach to more robust investigations could increase knowledge of the association between particular injuries and corresponding functional impairments, improving understanding of both time course and prognosis for resolution of injury. Our findings identify targets for future research and highlight the long-known, but understudied, clinical outcomes from endotracheal intubation with mechanical ventilation in ICU.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/efeitos adversos , Laringe/lesões , Respiração Artificial/efeitos adversos , Humanos , Prevalência , Índices de Gravidade do Trauma
13.
J Surg Educ ; 75(5): 1264-1275, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628333

RESUMO

OBJECTIVE: A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC). DESIGN: The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management. The MDAC occurs within the Johns Hopkins Medicine Simulation Center approximately four times per year and uses a combination of didactic lectures, hands-on sessions, and high-fidelity simulation training. Participation in MDAC is the main intervention being investigated in this study. Data were collected prospectively using course evaluation survey with quantitative and qualitative components, and prepost course knowledge assessment multiple choice questions (MCQ). Outcomes include course evaluation scores and themes derived from qualitative assessments, and prepost course knowledge assessment MCQ scores. SETTING: Tertiary care academic hospital center PARTICIPANTS: Students, residents, fellows, and practicing physicians from the departments of Surgery, Otolaryngology Head and Neck Surgery, Anesthesiology/Critical Care Medicine, and Emergency Medicine; advanced practice providers (nurse practitioners and physician assistants), nurse anesthetists, nurses, and respiratory therapists. RESULTS: Totally, 23 MDACs have been conducted, including 499 participants. Course evaluations were uniformly positive with mean score of 86.9 of 95 points. Qualitative responses suggest major value from high-fidelity simulation, the hands-on skill stations, and teamwork practice. MCQ scores demonstrated significant improvement: median (interquartile range) pre: 69% (60%-81%) vs post: 81% (72%-89%), p < 0.001. CONCLUSIONS: Implementation of a MDAC successfully disseminated principles and protocols to all airway providers. Demonstrable improvement in prepost course knowledge assessment and overwhelmingly positive course evaluations (quantitative and qualitative) suggest a critical and ongoing role for the MDAC course.


Assuntos
Manuseio das Vias Aéreas/métodos , Competência Clínica , Equipe de Respostas Rápidas de Hospitais/organização & administração , Comunicação Interdisciplinar , Treinamento por Simulação/organização & administração , Emergências , Feminino , Cirurgia Geral/educação , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Estados Unidos
14.
15.
Otolaryngol Head Neck Surg ; 156(2): 321-328, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28112014

RESUMO

Objective Laryngotracheal stenosis (LTS) is a fibrotic process that narrows the upper airway and has a significant impact on breathing and phonation. Iatrogenic injury from endotracheal and/or tracheostomy tubes is the most common etiology. This study investigates differences in LTS etiologies as they relate to tracheostomy dependence and dilation interval. Study Design Case series with chart review. Setting Single-center tertiary care facility. Subjects and Methods Review of adult patients with LTS was performed between 2004 and 2015. The association of patient demographics, comorbidities, disease etiology, and treatment modalities with patient outcomes was assessed. Multiple logistic regression analysis and Kaplan-Meier analysis were performed to determine factors associated with tracheostomy dependence and time to second procedure, respectively. Results A total of 262 patients met inclusion criteria. Iatrogenic patients presented with greater stenosis ( P = .023), greater length of stenosis ( P = .004), and stenosis farther from the vocal folds ( P < .001) as compared with other etiologies. Iatrogenic patients were more likely to be African American, use tobacco, and have obstructive sleep apnea, type II diabetes, hypertension, chronic obstructive pulmonary disease, or a history of stroke. Iatrogenic LTS (odds ratio [OR] = 3.1, 95% confidence interval [95% CI] = 1.2-8.2), Cotton-Myer grade 3-4 (OR = 2.6, 95% CI = 1.1-6.4), and lack of intraoperative steroids (OR = 2.9, 95% CI = 1.2-6.9) were associated with tracheostomy dependence. Nonsmokers, patients without tracheostomy, and idiopathic LTS patients had a significantly longer time to second dilation procedure. Conclusion Iatrogenic LTS presents with a greater disease burden and higher risk of tracheostomy dependence when compared with other etiologies of LTS. Comorbid conditions promoting microvascular injury-including smoking, COPD, and diabetes-were prevalent in the iatrogenic cohort. Changes in hospital practice patterns to promote earlier tracheostomy in high-risk patients could reduce the incidence of LTS.


Assuntos
Doenças Autoimunes/complicações , Doença Iatrogênica , Laringoestenose/etiologia , Laringoestenose/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia , Adulto , Comorbidade , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
16.
J Crit Care ; 37: 173-178, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27756050

RESUMO

PURPOSE: Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway. We sought to identify predictors of nonstandard tracheostomy tubes. MATERIALS AND METHODS: In this matched case-control study at an urban, academic, tertiary care medical center, we reviewed 1220 records of patients who received a tracheostomy. Seventy-seven patients received nonstandard tracheostomy tubes (cases), and 154 received standard tracheostomy tubes (controls). RESULTS: Sex, endotracheal tube size, severity of illness, and computed tomography scan measurement of the distance from the trachea to the skin at the level of the superior aspect of the anterior clavicle were significant predictors of nonstandard tracheostomy tubes. Specifically, trachea-to-skin distance >4.4 cm and endotracheal tube sizes ≥8.0 were associated with nonstandard tracheostomy. CONCLUSIONS: The findings suggest that clinicians should consider using nonstandard tracheostomy tubes as the first choice if the patient is male with an endotracheal tube size ≥8.0 and has a trachea-to-skin distance >4.4 cm on the computed tomography scan.


Assuntos
Estado Terminal , Intubação Intratraqueal/instrumentação , Insuficiência Respiratória/terapia , Traqueostomia/instrumentação , Estudos de Casos e Controles , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Respiratória/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem
17.
ORL Head Neck Nurs ; 34(1): 17-8, 20-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27164767

RESUMO

AIM: The aim of this review was to assess and synthesize current literature evaluating caregiver education and coping after children were discharged with a tracheostomy. BACKGROUND: Tracheostomy tube placement is a transformative event for the child who receives it and the family members who care for the child. As a result, it is imperative to provide caregivers a comprehensive and effective education on how to care for the tracheostomy and how to cope with a tracheostomy. DESIGN: A systematic review of literature was conducted to explore practices associated with tracheostomy education among caregivers of pediatric patients with a tracheostomy. METHODS: A search of PubMed, CINAHL, and Web of Science revealed potential 501 articles using keywords, tracheostomy, tracheotomy, education, discharge, caregiver, and family coping. After reviewing them in a systematic fashion, 12 articles were identified that were pertinent to tracheostomy education. FINDINGS: This review of literature showed that discrepancies existed in how discharge education was provided and the lack of knowledge regarding tracheostomy care among caregivers despite formal education. Moreover, the caregivers reported variations in their coping capabilities and quality of life while caring for their children with a tracheostomy tube. CONCLUSION: Literature on discharge education regarding tracheostomy management among caregivers of children with a tracheostomy tube is limited. Studies report poor coping strategies and quality of life among caregivers of children with a tracheostomy tube. Studies have significant limitations. Further research is warranted to understand the current practices with discharge education and follow-up of these patients at home settings.


Assuntos
Adaptação Psicológica , Cuidadores/educação , Cuidadores/psicologia , Educação de Pacientes como Assunto , Pacientes/psicologia , Traqueostomia/educação , Traqueostomia/enfermagem , Adolescente , Criança , Pré-Escolar , Feminino , Educação em Saúde , Humanos , Lactente , Masculino , Qualidade de Vida , Estresse Psicológico
18.
Ann Otol Rhinol Laryngol ; 125(3): 257-63, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26466860

RESUMO

OBJECTIVE: To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients. METHODS: Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU). RESULTS: Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy. CONCLUSION: Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.


Assuntos
Intubação Intratraqueal/efeitos adversos , Laringoestenose/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Intubação Intratraqueal/instrumentação , Isquemia/complicações , Laringoestenose/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Fatores de Tempo , Traqueostomia , Resultado do Tratamento
20.
Anesth Analg ; 121(1): 127-39, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26086513

RESUMO

BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.


Assuntos
Serviço Hospitalar de Emergência/normas , Intubação Intratraqueal/normas , Equipe de Assistência ao Paciente/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Idoso , Baltimore , Comportamento Cooperativo , Análise Custo-Benefício , Emergências , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Custos Hospitalares , Humanos , Capacitação em Serviço , Comunicação Interdisciplinar , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/economia , Intubação Intratraqueal/mortalidade , Masculino , Pessoa de Meia-Idade , /organização & administração , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Medição de Risco , Fatores de Risco , Fatores de Tempo
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