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Health crews & tracheostomy anchors? Navigation to improved patient management

Health crews & tracheostomy anchors? Navigation to improved patient management. Tracheostomy & Critical Care Discussion and EBP group Extravaganza 2010. 2010 Review. Held Trache Ed day – April 2010 Developed Trache Handover Form – awaiting ratification

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Health crews & tracheostomy anchors? Navigation to improved patient management

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  1. Health crews & tracheostomy anchors? Navigation to improved patient management Tracheostomy & Critical Care Discussion and EBP group Extravaganza 2010

  2. 2010 Review • Held Trache Ed day – April 2010 • Developed Trache Handover Form – awaiting ratification • 2009 CAT – Trache MDT – clinical application • Completed 2010 CAT

  3. Taking you back to 2009 CAT • 3 articles critiqued • MDT = Pt outcome • Population specific evidence • Preliminary data In patients with a tracheostomy, does management by an identified multidisciplinary team improve patient outcome?

  4. Clinical application in 2010 • Using the evidence • Thinking about MDT and trache Mx • Engaging in service delivery change • Shift towards MDT management • All professions getting on board

  5. CAT 2010 Does the presence of a tracheostomy tube impact on swallow function?

  6. Researching the evidence • 20 articles - 7 appropriate • Interesting facts/ideas along the way • Articles of interest • Research design & methodology • Statistical significance • Animal testing!!!

  7. CAP 1 – Leader & Ross 2000 • Prospective consecutive case series • N = 23 (20 experimental and 3 controls) • Range of diagnoses • FEES conducted pre & post tracheostomy • Outcome = presence of aspiration Clinical bottom line: Presence of a trache tube does not impact on presence or absence of aspiration.

  8. CAP 2 – Leader & Ross 2005 • N = 22 • Head & Neck cancer patients • FEES conducted under 3 conditions • Outcome = presence of aspiration Clinical bottom line: Presence of a trache tube (including occlusion status) does not impact on aspiration status in post op H&N patients.

  9. CAP 3 – Terk et al. 2007 • Prospective crossover study • N = 7 • Range of diagnoses • MBS conducted under 3 conditions • Outcome = larynx-to-hyoid bone approximation and maximum hyoid bone displacement Clinical bottom line: Presence of a trache tube (including occlusion status) does not prevent normal hyoid bone and laryngeal movement when swallowing a liquid bolus

  10. CAP 4 – Brady et al. 2009 • Prospective case series • N = 6 • Range of diagnoses • FEES conducted under 4 conditions • Outcome = penetration-aspirationscale, durational measure of swallow initiation time and complete “whiteout” time Clinical bottom line: Presence of a trache tube (including occlusion status) does not impact on penetration-aspiration status and durational measures of swallow initiation and laryngeal closure

  11. CAP 5 – Leader & Ross 2010 • Direct replication study (2000) • N = 25 • FEES pre and post-tracheostomy • Series of food and fluid trialled • Outcome = presence of aspiration Clinical bottom line: No causal relationship between aspiration and presence of a tracheostomy with 90% of patients exhibiting the same aspiration status

  12. CAP 6 – McMahon 2003 • Critical appraisal of literature (1960-1996) • 19 articles discussed • Clinical evidence suggests tracheostomy influences swallowing • Swallow co-ordination, laryngeal elevation and glottic closure likely to be impacted Clinical bottom line: Limited scientific evidence (low to moderate) exists to support the documented clinical evidence of impact of a tracheostomy on swallow.

  13. CAP 7 – Donzelli et al. 2005 • Prospective repeated-measure design study • N = 37 • FEES pre and post tracheostomy • Puree bolus • Outcomes = aspiration and laryngeal penetration Clinical bottom line: No cause-and-effect relationship between the presence of a tracheostomy tube and aspiration. Aspiration status in agreement with and without trache in 95% of participants.

  14. Group Discussion • More research needed • Population specific research • Sample size • Other swallow parameters need to be researched • E.g. sensation, swallow pressures etc…

  15. Clinical Bottom Line - CAT The current literature does not support that the presence of a tracheostomy tube impacts on swallow function. Due to large range of diagnoses within small participant numbers as well as that not all measures of swallow function were looked at we still cannot rule out a causal relationship between tracheostomy presence and swallow function. Further research is required.

  16. Clinical implications • Heavier consideration of diagnosis and co-morbidities rather than the presence of trache • Adjust our rationales to doctors & patients • E3BP – Collect anecdotal data on patients • Cohort of patients

  17. Future Directions • Ideas for CAT 2011 • Stoma suturing • Intubation • Suctioning and impact on secretions and sensation • Sensitivity of bedside assessment in critical care • Group direction • Opportunities for PD • Successful video teleconferencing and active participation of rural members • Updates on current trache equipment • trache education day 2011

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