Eastern Health, Box Hill VIC, Australia.
J Crit Care. 2013 Apr;28(2):216.e1-10. doi: 10.1016/j.jcrc.2012.05.005. Epub 2012 Aug 27.
Multidisciplinary tracheostomy teams have been implemented in acute hospitals over the past 10 years. This systematic review of the literature and meta-analysis aimed to assess the effect of tracheostomy teams on patient outcomes.
We conducted an electronic search of the literature in the following databases: MEDLINE, CINAHL, EMBASE, and AMED. Inclusion/exclusion criteria were applied, and included articles were assessed against quality criteria. Qualitative synthesis and meta-analysis were completed.
Seven studies were included. The studies were all pre-post cohort designs of low-moderate quality. Meta-analysis showed that tracheostomy teams were associated with reductions in total tracheostomy time (4 studies; mean difference, 8 days; 95% confidence interval, 6-11; P < .01; I(2) = 0%) and hospital length of stay (LOS) (3 studies; mean difference, -14 days; 95% confidence interval, -39 to 9; P = .23; I(2) = 50%). Reductions in intensive care unit LOS (3 studies) and increases in speaking valve (3 studies) use were also reported with tracheostomy teams.
There is low-quality evidence that multidisciplinary tracheostomy care contributes to a reduction in total tracheostomy time and increase speaking valve use for patients leading to improved quality of life. There is insufficient evidence to determine that multidisciplinary tracheostomy teams reduce hospital or intensive care unit LOS.
多学科气管切开术团队在过去 10 年中已在急性医院中实施。本系统评价文献和荟萃分析旨在评估气管切开术团队对患者结局的影响。
我们在以下数据库中进行了文献的电子检索：MEDLINE、CINAHL、EMBASE 和 AMED。应用了纳入/排除标准，并根据质量标准评估了纳入的文章。完成了定性综合和荟萃分析。
纳入了 7 项研究。这些研究均为低质量至中等质量的前后队列设计。荟萃分析显示，气管切开术团队与总气管切开时间的缩短（4 项研究；平均差异，8 天；95%置信区间，6-11；P<.01；I²=0%）和住院时间（LOS）的缩短（3 项研究；平均差异，-14 天；95%置信区间，-39 至 9；P=.23；I²=50%）相关。还报告了气管切开术团队与重症监护病房 LOS 的缩短（3 项研究）和说话瓣膜（3 项研究）使用率的增加有关。
有低质量证据表明，多学科气管切开术护理有助于缩短总气管切开时间，并增加使用说话瓣膜，从而提高患者的生活质量。没有足够的证据表明多学科气管切开术团队可以减少医院或重症监护病房的 LOS。
