Rassekh Christopher H, Zhao Jing, Martin Niels D, Chalian Ara A, Atkins Joshua H
Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Anesthesiology, Peking Union Medical College Hospital, Dongcheng District, Beijing.
Otolaryngol Head Neck Surg. 2015 Dec;153(6):921-6. doi: 10.1177/0194599815612759. Epub 2015 Oct 30.
To analyze the subset of airway rapid response (ARR) calls related to tracheostomy identified over a 46-month period from August 2011 to May 2015 to determine proximate cause, intervention, and outcome and to develop process improvement initiatives.
Single-institution multidisciplinary retrospective cohort study.
Tertiary care academic medical center in a large urban setting.
Hospital inpatients with an in situ tracheostomy or laryngectomy who experienced an ARR.
Detailed review of operator, hospital, and patient records related to ARR system activations over a 46-month period.
ARR was activated for 28 patients with existing tracheostomy. The cohort included open tracheostomy (n = 14), percutaneous tracheostomy (n = 8), laryngectomy stoma (n = 3), and indeterminate technique (n = 3). The most frequent triggers for emergency airway intervention were decannulation (n = 16), followed by mucus plugging (n = 4). The mean body mass index of ARR patients was higher than that of a comparator tracheostomy cohort (32.9 vs 26.3, P < .001). BMI was >40 in 9 ARR patients. There was 1 mortality in the series.
Tracheostomy is a major trigger for ARR with potential fatal outcome. Factors that may contribute to tracheostomy emergencies include high body mass index, surgical technique for open tracheostomy or percutaneous tracheostomy, tracheostomy tube size, and bedside tracheostomy management. Results have triggered a hospital-wide practice improvement plan focused on tracheostomy awareness and documentation, discrete process changes, and implementation of guidelines for emergency management.
分析2011年8月至2015年5月这46个月期间与气管造口术相关的气道快速反应（ARR）呼叫子集，以确定近因、干预措施和结果，并制定流程改进措施。
单机构多学科回顾性队列研究。
大型城市环境中的三级医疗学术医学中心。
接受原位气管造口术或喉切除术且经历过ARR的住院患者。
详细回顾46个月期间与ARR系统激活相关的操作员、医院和患者记录。
28例现有气管造口术患者激活了ARR。队列包括开放式气管造口术（n = 14）、经皮气管造口术（n = 8）、喉切除造口术（n = 3）和技术不确定（n = 3）。紧急气道干预最常见的触发因素是脱管（n = 16），其次是黏液堵塞（n = 4）。ARR患者的平均体重指数高于对照气管造口术队列（32.9对26.3，P <.001）。9例ARR患者的BMI>40。该系列中有1例死亡。
气管造口术是ARR的主要触发因素，具有潜在致命后果。可能导致气管造口术紧急情况的因素包括高体重指数、开放式气管造口术或经皮气管造口术的手术技术、气管造口管尺寸以及床边气管造口术管理。结果引发了一项全院范围的实践改进计划，重点是气管造口术的认识和记录、离散流程变更以及实施应急管理指南。
