Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: A systematic review and meta-analysis

Speed, Lauren; Harding, Katherine E

doi:10.1016/j.jcrc.2012.05.005

Cited by 66 publications

(68 citation statements)

References 23 publications

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“…In their recent meta-analysis of seven trials, Speed and Harding found low-quality evidence that this collaborative and holistic treatment provided by the multidisciplinary team may shorten total tracheotomy time with a mean reduction of 8 days. Apart from that, length of stay on the ICU might also be reduced and the use of speaking valves enhanced [38]. In the context of this less standardized treatment option the present study provides the first evidence that a short and well-defined intervention may reasonably help to achieve the ultimate goal of decannulation.…”

Section: Discussionmentioning

confidence: 77%

Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

et al. 2015

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Section: Discussionmentioning

confidence: 77%

Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

et al. 2015

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“…There is sufficient evidence that people are better managed with a tracheostomy team [94][95][96][97][98][99][100][101] including those with a traumatic brain injury [102]. Furthermore, there is support for those with saliva management issues to be managed better within a team setting [23,77,78,87,103].…”

Section: Discussionmentioning

confidence: 99%

Saliva management options for difficult-to-wean people with tracheostomy following severe acquired brain injury (ABI): A review of the literature

et al. 2014

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There is a paucity of evidence in this area and clinical decision-making requires evidence from other populations. Saliva management issues in this population are most likely to be related to dysphagia. Treatment options include behavioural/compensatory therapies which should be tried in all cases, with adjunct pharmaceutical therapies or surgical options to reduce saliva volume as clinically appropriate. CONCLUSION AND FUTURE DIRECTIONS: This group of people is complex and requires a multi-disciplinary team to guide decision-making. High quality control studies looking at the effectiveness of dysphagia therapy and guidelines regarding botulinum toxin injections are recommended.

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“…Others have demonstrated improved time to decannulation only. Speed et al 18 performed a metaanalysis demonstrating a reduction of total in situ tracheostomy time. This study included 7 articles, all scoring low on internal validity and 2 scoring low for external validity.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, few studies have examined this progression in regard to more frequent decannulations, improvements in speech function, or tolerance of an oral diet, with many studies limited by design, power, or validity. 18 With the success of bundled therapy 19 in multiple other areas of medicine, including reduction in urinary tract infections, sepsis, ventilator-associated pneumonia, and catheter-related bloodstream infections, [20][21][22][23] we hypothesized that adding a post-tracheostomy care bundle to our existing tracheostomy service would improve rates of decannulation and swallowing function. The bundle included a process to identify and follow all patients immediately after tracheostomy, established a consistent method to deliver postoperative care, and organized all essential providers with the goal of progressing all patients to their maximal clinical potential.…”

Section: Introductionmentioning

confidence: 99%

Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care

et al. 2016

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BACKGROUND: Multidisciplinary tracheostomy teams have been successful in improving operative outcomes; however, limited data exist on their effect on postoperative care. We aimed to determine the effectiveness of a multidisciplinary tracheostomy service alone and following implementation of a post-tracheostomy care bundle on rates of decannulation and tolerance of oral diet before discharge. METHODS: Prospective data on all subjects requiring tracheostomy by any trauma/ critical care surgeon were collected from January 2011 to December 2013 following development of a tracheostomy service and continued following implementation of the post-tracheostomy care bundle. Rates of decannulation and tolerance of oral diet were compared between all groups: pre-tracheostomy service (baseline, historical control), tracheostomy service alone, and tracheostomy service with post-tracheostomy care bundle. RESULTS: Three hundred ninety-three subjects met the criteria for analysis with 61 in the baseline group, 124 following initiation of a tracheostomy service, and 208 after the addition of the post-tracheostomy care bundle. There were significant overall differences between all groups in the proportion of subjects decannulated, proportion of subjects tolerating oral diet, and number of subjects receiving speech evaluations. Pairwise comparisons showed no differences in decannulation or tolerance of oral diet following implementation of the tracheostomy service alone but significant improvement with the addition of the posttracheostomy care bundle compared with baseline. (P ‫؍‬ .002 and P ‫؍‬ .005, respectively). Likewise, the number of speech language pathologist consults significantly increased compared with baseline only after the post-tracheostomy care bundle (P ‫؍‬ .004). Time to speech evaluation significantly decreased with the post-tracheostomy care bundle compared with baseline and tracheostomy service (P < .013). CONCLUSIONS: The addition of a post-tracheostomy care bundle to a multidisciplinary tracheostomy service significantly improved rates of decannulation and tolerance of oral diet.

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Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: A systematic review and meta-analysis

Cited by 66 publications

References 23 publications

Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

Saliva management options for difficult-to-wean people with tracheostomy following severe acquired brain injury (ABI): A review of the literature

Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care

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