Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

Abstract

SummaryAdult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multi‐disciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.

Tracheostomy Care and Complications in the Intensive Care Unit

“…43 When the stoma is immature, mask ventilation with the cuff deflated is usually the best intervention, and then an orotracheal tube should be inserted. 48 After the airway is secure, the tracheostomy can be revised under more controlled circumstances.…”

“…If a tracheostomy tube is changed prematurely, the tissue of the dilated stoma tract is more likely to recoil than it would if the change were done later. 18 In addition, Mitchell et al 2 recommend that patients should not be discharged from the hospital with the tracheostomy tube sutured in place because the first tracheostomy tube change should be done before discharge.…”

Consenso sobre el cuidado del niño con traqueostomía

“…Por lo tanto, mejorar las competencias de los cuidadores y profesionales vinculados en el cuidado de los niños con traqueostomía resulta primordial para mejorar la seguridad y promover la inclusión social de este grupo de niños. [1][2][3][4] La traqueostomía es un procedimiento muy antiguo 5 que consiste en abocar la tráquea a la piel de manera de asegurar la vía aérea y su abertura se sostiene mediante una cánula de traqueostomía. En las últimas déca-das, como contracara de los avances en los cuidados críticos pediátricos y neonatales, el número de niños que ha requerido una traqueostomía se ha incrementado.…”

Improving the quality of tracheostomy care

“…These were developed by consensus, using existing guidelines, evidence and experiences of stakeholders and reinforced by open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders [34].…”