Mondrup Frederik, Skjelsager Karen, Madsen Kristian Rørbæk
Anæstesiologisk Afdeling, Næstved Sygehus, 4700 Næstved, Denmark.
Dan Med J. 2012 Aug;59(8):A4481.
When patients are transferred from intensive care units (ICUs) to general wards with a tracheostomy in situ, there is a risk of suboptimal care and increased morbidity. The aim of this study was to elucidate the management of patients with a tracheostomy in situ at discharge from the ICU to the ward.
We performed an electronic questionnaire survey among heads of unit at registered Danish ICUs.
A total of 34 out of 43 ICUs responded. 56% of the ICUs do not document individual plans for decannulation in the patient's chart. 91% of the ICUs do not perform daily follow-up of tracheotomised patients on the ward. No guidelines for decannulation on the ward were found, and only 6% have a guideline for accidental decannulation. Furthermore, as little as 47% of the ICUs report any formalized education or training of staff nurses in the management of tracheotomised patients.
Guidelines relevant to patients discharged from Danish ICUs with a tracheal cannula in situ are scarce; few ICUs employ individualized plans for tracheostomy management and decannulation; there is largely no daily intensivist-led post-ICU follow-up, and formal staff education in tracheostomy management on the ward is scarce. Altogether these factors create a potential for adverse events and increased morbidity in this high-risk, high-cost patient population. Possibly individualized plans for tracheotomised patients as well as intensivist-led follow-up on the ward can improve patient outcome and safety and this should be confirmed in a future study.
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当患者带着气管造口术从重症监护病房（ICU）转至普通病房时，存在护理欠佳及发病率增加的风险。本研究的目的是阐明从ICU转至病房时仍保留气管造口术的患者的管理情况。
我们对丹麦注册ICU的科室主任进行了电子问卷调查。
43个ICU中共有34个做出了回应。56%的ICU未在患者病历中记录脱管的个体化计划。91%的ICU未对病房中接受气管切开术的患者进行每日随访。未发现病房脱管指南，仅有6%有意外脱管指南。此外，仅有47%的ICU报告对护士进行过气管切开术患者管理方面的任何正规教育或培训。
丹麦ICU中有关带气管套管出院患者的指南稀缺；很少有ICU采用气管造口术管理和脱管的个体化计划；基本上没有由重症监护医生主导的每日ICU后随访，病房中气管造口术管理方面的正规员工教育也很稀缺。这些因素共同导致了这一高风险、高成本患者群体出现不良事件及发病率增加的可能性。气管切开术患者的个体化计划以及重症监护医生主导的病房随访可能会改善患者的治疗效果和安全性，这一点应在未来的研究中得到证实。
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