https://doi.org/10.4081/monaldi.2022.2451

How the work of respiratory physiotherapists changes the tracheostomy management and decannulation in a NICU department: an Italian experience

Vol. 93 No. 3 (2023)
Published: November 24, 2022
decannulation, physiotherapy, intensive care unit, physical therapy, tracheostomy, tracheotomy
Abstract Views: 2100
PDF: 592
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Davide Papi
davidepapi@gmail.com
NeuroIntensive Care Unit, Careggi University Hospital, Florence, Italy.
Giulia Montigiani
NeuroIntensive Care Unit, Careggi University Hospital, Florence, Italy.
Luca Bucciardini
https://orcid.org/0000-0003-4790-6494
NeuroIntensive Care Unit, Careggi University Hospital, Florence, Italy.

Tracheotomy is a clinical procedure that is often necessary though not without complications, hence the need for appropriate and timely decannulation. The inclusion of trained respiratory physiotherapists (RPT) in the staff and the use of shared protocols could help the team to manage the patient with tracheotomy cannula. The objective of this study was to describe the difference in the rate of decannulation and clinical outcomes of tracheostomized patients admitted to a NeuroIntensive Care Unit (NICU) team after the inclusion of a group of physiotherapists specialized in respiratory physiotherapy and a new phoniatric protocol. It is a 6-year retrospective study, in which two periods of 3 years each were compared: in the first period (P1: September 2013-August 2016) physiotherapists were called to treat NICU patients on a consultative basis (2 hours/day for 5 days a week); in the second period (P2: September 2016-August 2019) two full-time respiratory physiotherapists were present on the ward (7 hours/day, 6/7 days/week). In P2 period, a decannulation protocol was used. Patients who had undergone a tracheotomy procedure and who were alive at the time of discharge were retrospectively evaluated. We described the number of decannulations, the length of stay in NICU and decannulation time; the diagnosis of decannulated patients and the number of deaths. 928 total patients were analysed: 468 in P1, 460 in P2. Total length of stay or number of deaths did not change significantly between the two periods, while the number of decannulated patients before the discharge was higher in P2 143 (64%), compared with P1 79 (36%) p<0.001. More patients with neurological pathologies involving possible swallowing disorders, such as cerebral haemorrhage, head trauma and stroke, have been successfully decannulated in P2 than in P1 (120 patients in P2 vs 54 in P1). A multidisciplinary approach, including respiratory physiotherapist, dedicated to tracheostomy management, decannulation and early mobilization in NICU is safe, feasible and seems to improve the number of severe patients decannulated, even if no change was observed in NICU length of stay or deaths. Further studies must confirm our results in other ICU settings.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Krishnamoorthy V, Hough CL, Vavila MS, et al. Tracheostomy after severe acute brain injury: trends and variability in the USA. Neurocrit Care 2019;30:546–4. DOI: https://doi.org/10.1007/s12028-019-00697-5
Robba C, Galimberti S, Graziano F, et al. Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study. Intensive Care Med 2020;46:983–4. DOI: https://doi.org/10.1007/s00134-020-05935-5
Hillejan L, Rawert H. [Tracheotomy - surgical and percutaneous].[Article in German with English abstract]. Zentralbl Chir 2015;3:339–58. DOI: https://doi.org/10.1055/s-0035-1546135
McCredie VA, Alali AS, Scales DC, et al. Effect of early versus late tracheostomy or prolonged intubation in critically ill patients with acute brain injury: a sytematic review and meta-analysis. Neurocrit Care 2017;26:14–25. DOI: https://doi.org/10.1007/s12028-016-0297-z
De Franca SA, Tavare WM, Salinet ASM, et al. Early tracheostomy in severe traumatic brain injury patients: A meta-analysis and comparison with late tracheostomy. Crit Care Med 2020;3:e325–31. DOI: https://doi.org/10.1097/CCM.0000000000004239
Fernandez-Bussy S, Mahajan B, Floch E, et al. Tracheostomy tube placement: early and late complications. J Bronchol Interv Pulmonol 2015;22:357–64. DOI: https://doi.org/10.1097/LBR.0000000000000177
Santus P, Gramegna A, Radovanovic D, et al. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med 2014;14:1–8. DOI: https://doi.org/10.1186/1471-2466-14-201
Cox CE, Carson SS, Holmes GM, et al. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med 2004;32:2219–26. DOI: https://doi.org/10.1097/01.CCM.0000145232.46143.40
Hussey JD, Bishop MJ. Pressures required to move gas through the native airway in the presence of a fenestrated vs a nonfenestrated tracheostomy tube. Chest 1996;110:494-7. DOI: https://doi.org/10.1378/chest.110.2.494
Keren O, Cohen M, Lazar-Zweker I, Groswasser Z. Tracheotomy in severe TBI patients: Sequelae and relation to vocational outcome. Brain Inj 2001;15:531-6. DOI: https://doi.org/10.1080/02699050010007371
Jenkins R, Badjiatia N, Haac B, et al. Factors associated with tracheostomy decannulation in patients with severe traumatic brain injury. Brain Inj 2020;341106-11.
Kutsukutsa J, Kuupiel D, Monori-Kiss, et al. Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults: A systematic scoping review. Int J Evid Based Healthc 2019;17:74–91. DOI: https://doi.org/10.1097/XEB.0000000000000166
Stelfox HT, Crimi C, Berra L, et al. Determinants of tracheostomy decannulation: an international survey. Crit Care 2008;12:R26. DOI: https://doi.org/10.1186/cc6802
de Medeiros GC, Sassi FC, Lirani-Silva C, de Andrade CRF. Criteria for tracheostomy decannulation: Literature review. Codas 2019;31:e20180228. DOI: https://doi.org/10.1590/2317-1782/20192018228
Perin C, Meroni R, Rega V, et al. Parameters influencing tracheostomy decannulation in patients undergoing rehabilitation after severe acquired brain injury (sABI). Int Arch Otorhinolaryngol 2017;21:383-9. DOI: https://doi.org/10.1055/s-0037-1598654
Enrichi C, Battel I, Zanetti C, et al. Clinical criteria for tracheostomy decannulation in subjects with acquired brain injury. Respir Care 2017;62;1255–63. DOI: https://doi.org/10.4187/respcare.05470
Reverberi C, Lombardi F, Lusuardi M, et al. Development of the decannulation prediction tool in patients with dysphagia after acquired brain injury. J Am Med Dir Assoc 2019;20:470-5. DOI: https://doi.org/10.1016/j.jamda.2018.09.022
Hernández Martínez G, Rodriguez M-K, Vaquero M-C, et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med 2020;383:1009–17. DOI: https://doi.org/10.1056/NEJMoa2010834
Kim DH, Kang SW, Choi WA, Oh HJ. Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury. Spinal Cord 2017;55:601–5. DOI: https://doi.org/10.1038/sc.2016.194
MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Medicine. Chest 2001;120:375-95. DOI: https://doi.org/10.1378/chest.120.6_suppl.375S
O’Connor H, White AC. Tracheostomy decannulation. Respir Care 2010;55:1076–81.
Garrubba M, Turner T, Grieveson C. Multidisciplinary care for tracheostomy patients: a systematic review. Crit Care 2009;13:R177. DOI: https://doi.org/10.1186/cc8159
StillerK. Physiotherapy in intensive care: an updated systematic review. Chest 2013;144:825–47. DOI: https://doi.org/10.1378/chest.12-2930
Combes A, Luyt C-E, Nieszkowska A, et al. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Crit Care Med 2007;35:802–7. DOI: https://doi.org/10.1097/01.CCM.0000256721.60517.B1
Divo MJ. Post-tracheostomy care: bundle up for success! Respir Care 2017;62:246-7. DOI: https://doi.org/10.4187/respcare.05410
Frank U, Mäder M, Sticher H. Dysphagic patients with tracheotomies: a multidisciplinary approach to treatment and decannulation management. Dysphagia 2007;22:20–9. DOI: https://doi.org/10.1007/s00455-006-9036-5
Andriolo BNG, Andriolo RB, Saconato H, et al. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst 2015;1:CD007271. DOI: https://doi.org/10.1002/14651858.CD007271.pub3
Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med 2018;6:384. DOI: https://doi.org/10.21037/atm.2018.05.50
Salvitti S, Repossini E. Perception, experience, and knowledge of early physiotherapy in intensive care units of Rome: a survey. Monaldi 2020;90:1412. DOI: https://doi.org/10.4081/monaldi.2020.1412

How to Cite

Papi, Davide, Giulia Montigiani, and Luca Bucciardini. 2022. “How the Work of Respiratory Physiotherapists Changes the Tracheostomy Management and Decannulation in a NICU Department: An Italian Experience”. Monaldi Archives for Chest Disease 93 (3). https://doi.org/10.4081/monaldi.2022.2451.
Copyright (c) 2022 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

<< < 15 16 17 18 19 20 21 22 23 24 > >> 

You may also start an advanced similarity search for this article.