Department of Critical Care, SPS Apollo Hospitals, Ludhiana, India,
J Anesth. 2014 Jun;28(3):374-80. doi: 10.1007/s00540-013-1718-1. Epub 2013 Oct 6.
Tracheostomy is a common occurrence in intensive care units (ICU), and a greater number of tracheostomized patients are shifted from ICU to non-critical areas. Tracheostomy care needs a multidisciplinary approach, particularly involving the nurses, and complications such as tube blockage, infection, and bleeding can be prevented by good bedside nursing. The aim was to study the impact of dedicated tracheostomy care nurse program on outcomes of tracheostomized patients.
A tracheostomy care nurse program was improvised by the critical care physicians, with the objective of improving care of tracheostomized patients, wherein nursing staff from noncritical areas were selected for training purposes. The training included evidence-based knowledge and hands-on training. After a written assessment and a skill test, they were certified as 'Tracheostomy Care Nurse.' At least one of the tracheostomy care nurses was supposed to be responsible for tracheostomy care in specific wards. Comparative data of two periods, a pre-intervention period from January 2011 to November 2011 and a post-intervention period from December 2011 to October 2012, were analyzed.
During the pre-intervention period, of 82 tracheostomized patients, 28 (34.15 %) had complications including 20 (24.39 %) readmissions to the ICU. During the post-intervention period, 107 patients had a tracheostomy, of which 7 (6.54 %) had complications with only 2 (1.87 %) readmissions, which was significant (p < 0.05). Decannulations nonsignificantly increased during the post-intervention period (25 vs. 16 %, p > 0.05). The average length of hospital stay (ALOS) decreased from 36 to 27 days (p < 0.05).
The support of a specialist tracheostomy nurse can decrease complication rates and readmissions to the ICU and reduce ALOS.
气管切开术在重症监护病房（ICU）中很常见，越来越多的气管切开患者从 ICU 转移到非重症区域。气管切开护理需要多学科方法，特别是涉及护士，通过良好的床边护理可以预防管腔堵塞、感染和出血等并发症。目的是研究专门的气管切开护理护士计划对气管切开患者结局的影响。
由重症监护医生制定了气管切开护理护士计划，目的是改善气管切开患者的护理，为此从非重症区域选拔护理人员进行培训。培训包括循证知识和实践培训。经过书面评估和技能测试后，他们被认证为“气管切开护理护士”。至少有一名气管切开护理护士负责特定病房的气管切开护理。分析了两个时期的对比数据，干预前时期为 2011 年 1 月至 2011 年 11 月，干预后时期为 2011 年 12 月至 2012 年 10 月。
在干预前时期，82 例气管切开患者中有 28 例（34.15%）发生并发症，其中 20 例（24.39%）重新入住 ICU。在干预后时期，有 107 例患者进行了气管切开术，其中 7 例（6.54%）发生并发症，仅 2 例（1.87%）重新入住 ICU，差异有统计学意义（p<0.05）。干预后时期的拔管率显著增加（25%比 16%，p>0.05）。平均住院时间（ALOS）从 36 天减少到 27 天（p<0.05）。
专科气管切开护理护士的支持可以降低并发症发生率和 ICU 重新入院率，并缩短平均住院时间。
