专门的多学科气管切开术团队对危重症患者气管切开护理的影响。
Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients.
机构信息
The Department of Surgery, McGill University Health Centre, Montréal, Que., Canada.
出版信息
Can J Surg. 2011 Jun;54(3):167-72. doi: 10.1503/cjs.043209.
BACKGROUND
A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward.
METHODS
This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team.
RESULTS
There were 32 patients in the preservice group and 54 patients in the postservice group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p < 0.001) after creation of the team. Furthermore, there appeared to be a decreased time to first tube downsizing (26.0 to 9.4 d) and decreased time to decannulation (50.4 to 28.4 d), although this did not reach statistical significance owing to our small sample size.
CONCLUSION
Standardized care provided by a specialized multidisciplinary tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve.
背景
2005 年成立了一个多学科气管切开小组，负责跟踪接受气管切开术的重症患者，直到他们出院。该小组由一名外科医生、一名外科住院医师、一名呼吸治疗师、一名言语病理学家和一名临床护士专家组成，每周两次开会，涉及从重症监护病房（ICU）转至医疗和外科病房的患者。我们的目标是评估该多学科小组对缩小和拔管时间、使用说话阀的发生率以及病房内气管切开相关并发症发生率的影响。
方法
这项研究在一家三级护理、一级创伤中心和教学医院进行，涉及 2004 年 1 月 1 日至 12 月 31 日期间入住 ICU 并接受气管切开术的所有患者（服务前组），以及 2006 年 1 月 1 日至 12 月 31 日期间入住 ICU 并接受气管切开术的患者（服务后组）。我们比较了小组成立后 12 个月内需要进行气管切开术的患者的结果与小组成立前类似时间段内的患者结果。
结果
服务前组有 32 例患者，服务后组有 54 例患者。在新的气管切开术服务下，病房中出现管腔堵塞（5.5%比 25.0%，p=0.016）和呼吸窘迫呼叫（16.7%比 37.5%，p=0.039）的发生率降低。在小组成立后，接受说话阀的患者比例显著增加（67.4%比 19.4%，p<0.001）。此外，首次缩小管腔的时间似乎缩短（26.0 天到 9.4 天），拔管时间也缩短（50.4 天到 28.4 天），尽管由于样本量小，这并未达到统计学意义。
结论
由专门的多学科气管切开小组提供的标准化护理与气管切开相关并发症减少和说话阀使用增加有关。
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