Department of Speech Pathology, Division of Allied Health, Austin Health Melbourne, Australia; Tracheostomy Review and Management Service, Austin Hospital, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia.
Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Aust Crit Care. 2023 May;36(3):327-335. doi: 10.1016/j.aucc.2022.03.002. Epub 2022 Apr 27.
There is a paucity of literature in Australia on patient-focused tracheostomy outcomes and process outcomes. Exploration of processes of care enables teams to identify and address existing barriers that may prevent earlier therapeutic interventions that could improve patient outcomes following critical care survival.
The objectives of this study were to examine and provide baseline data and associations between tracheostomy clinical practices and patient outcomes across three large metropolitan hospitals.
We performed a retrospective multisite observational study in three tertiary metropolitan Australian health services who are members of the Global Tracheostomy Collaborative. Deidentified data were entered into the Global Tracheostomy Collaborative database from Jan 2016 to Dec 2019. Descriptive statistics were used for the reported outcomes of length of stay, mortality, tracheostomy-related adverse events and complications, tracheostomy insertion, airway, mechanical ventilation, communication, swallowing, nutrition, length of cannulation, and decannulation. Pearson's correlation coefficient and one-way analyses of variance were performed to examine associations between variables.
The total cohort was 380 patients. The in-hospital mortality of the study cohort was 13%. Overall median hospital length of stay was 46 days (interquartile range: 31-74). Length of cannulation was shorter in patients who did not experience any tracheostomy-related adverse events (p= 0.036) and who utilised nonverbal communication methods (p = 0.041). Few patients (8%) utilised verbal communication methods while mechanically ventilated, compared with 80% who utilised a one-way speaking valve while off the ventilator. Oral intake was commenced in 20% of patients prior to decannulation. Patient nutritional intake varied prior to and at the time of decannulation. Decannulation occurred in 83% of patients.
This study provides baseline data for tracheostomy outcomes across three large metropolitan Australian hospitals. Most outcomes were comparable with previous international and local studies. Future research is warranted to explore the impact of earlier nonverbal communication and interventions targeting the reduction in tracheostomy-related adverse events.
澳大利亚在以患者为中心的气管切开术结局和过程结局方面的文献很少。探索护理过程可以使团队识别和解决可能阻碍早期治疗干预的现有障碍，这些干预措施可能会改善重症监护存活后患者的结局。
本研究的目的是检查和提供三个大型大都市澳大利亚医院的气管切开术临床实践与患者结局之间的关联，并提供基线数据。
我们在三个三级大都市澳大利亚卫生服务机构中进行了回顾性多站点观察性研究，这些机构是全球气管切开术协作组织的成员。从 2016 年 1 月至 2019 年 12 月，将匿名数据输入全球气管切开术协作数据库。使用描述性统计方法报告了住院时间、死亡率、气管切开术相关不良事件和并发症、气管切开术插入、气道、机械通气、沟通、吞咽、营养、插管长度和拔管的结果。进行了 Pearson 相关系数和单向方差分析，以检查变量之间的关联。
总队列为 380 例患者。研究队列的院内死亡率为 13%。总体中位数住院时间为 46 天（四分位间距：31-74）。未发生任何气管切开术相关不良事件的患者（p=0.036）和使用非言语交流方法的患者（p=0.041）的插管长度较短。与使用通气机时使用言语交流方法的患者（8%）相比，在脱离通气机时使用单向说话阀的患者（80%）更少。在拔管前，20%的患者开始口服摄入。在拔管前和拔管时，患者的营养摄入量有所不同。83%的患者进行了拔管。
本研究为三家大型大都市澳大利亚医院的气管切开术结局提供了基线数据。大多数结局与之前的国际和本地研究相似。需要进一步研究，以探讨早期非言语交流和减少气管切开术相关不良事件的干预措施的影响。
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