Tracheostomy (Warrenville, Ill.)最新文献

{"title":"The Impact of Follow-Up Care on Tracheostomy Management Post-Hospital Discharge: A Longitudinal Cohort Study of Clinical Outcomes, Quality of Life, and Long-Term Recovery.","authors":"Vinciya Pandian, Carol S Maragos, Anjali Panickar, Jercilla Murmu, Therese Cole, Kathryn Mattare, Linda Williams, Alexander T Hillel, Elliott R Haut, David J Feller-Kopman","doi":"10.62905/001c.132162","DOIUrl":"10.62905/001c.132162","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy is a life-saving procedure associated with complex long-term care needs and potential complications, including stoma infections, respiratory challenges, and impaired quality of life (QoL). While follow-up care is widely recommended, its impact on adherence to maintenance practices, clinical outcomes, and long-term recovery has not been thoroughly evaluated.</p><p><strong>Objectives: </strong>This study examined the influence of follow-up care on tracheostomy management, adherence to care routines, clinical outcomes, and QoL three months and three-years post-discharge. Key objectives included assessing adherence to stoma cleaning and tube changes, evaluating complication rates, tracheostomy retention, and analyzing QoL outcomes in patients who received follow-up care compared to those who did not.</p><p><strong>Methods: </strong>A longitudinal cohort study was conducted at The Johns Hopkins Hospital, including 220 adult patients who underwent tracheostomy between 2007 and 2017. Data were collected through electronic health records and structured telephone surveys. Primary outcomes included adherence to maintenance practices, clinical complications, and health-related quality of life (HRQoL) measured using the SF-8 Health Survey. Statistical analyses included chi-square tests, t-tests, and multivariate regression.</p><p><strong>Results: </strong>Among 220 patients who completed the study, 166 (75.5%) received follow-up care. Patients with follow-up care demonstrated significantly higher adherence to stoma cleaning protocols (p = 0.001), although tube change frequency did not differ between groups (p = 0.37). Follow-up care was associated with more frequent identification of complications, including stoma infections (7.8% vs. 1.9%, p = 0.11) and respiratory difficulties (39.1% vs. 22.2%, p = 0.05). However, these differences were not statistically significant except for breathing difficulties. HRQoL analyses revealed marginally lower physical component scores (PCS) in the follow-up group (44.4 vs. 48.0, p = 0.03), while mental component scores (MCS) were comparable between groups (42.1 vs. 42.8, p = 0.66). At three years post-discharge, tracheostomy tube retention was low (6.8%), with stenosis being the most common reason for long-term tracheostomy dependence. Follow-up care was associated with a higher likelihood of timely tracheostomy tube removal and improved cosmetic outcomes.</p><p><strong>Conclusions: </strong>Follow-up care plays a critical role in improving adherence to tracheostomy maintenance and ensuring timely management of complications. However, disparities in QoL outcomes and care protocols highlight the need for standardized, multidisciplinary follow-up systems. Future research should explore scalable interventions, such as telehealth, to optimize care for tracheostomy patients and address barriers to equitable access.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"2 1","pages":"29-42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Tracheostomy and Association with Ventilator Liberation, Length of Stay, and Discharge Outcomes in Neurocritical Patients.","authors":"Michael A Amano, Mona N Bahouth, Bryce Kassalow, Daniel Hochster, Sarah E Hughes, Elizabeth K Zink, Michael J Brenner, Vinciya Pandian","doi":"10.62905/001c.133992","DOIUrl":"10.62905/001c.133992","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheostomy is frequently performed in neurocritical patients to facilitate airway management and ventilator liberation. However, the optimal timing of tracheostomy remains controversial, particularly in stroke patients, where earlier intervention may impact recovery and healthcare resource utilization. This study evaluates the association between early (<14 days) versus late (>14 days) tracheostomy and key clinical outcomes in stroke and non-stroke neurocritical care patients.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in a neuro-intensive care unit at an urban, quaternary care hospital. Adult patients (≥18 years) who underwent both percutaneous tracheostomy and gastrostomy between 2007 and 2013 were included. Demographics, admission Glasgow Coma Scale (GCS), hospital and intensive care unit (ICU) length of stay (LOS), ventilator days, reintubation rates, tracheostomy-related complications, costs, and discharge disposition were compared between stroke and non-stroke patients, as well as between early and late tracheostomy groups. Multivariable regression and competing risks models were used to adjust for confounders.</p><p><strong>Results: </strong>Among 290 patients (145 stroke, 145 non-stroke), early tracheostomy was associated with significantly shorter ICU LOS (21.7 vs. 27.6 days, p < 0.01), reduced hospital LOS (32.4 vs. 38.9 days, p < 0.01), and lower total hospital costs ($121,645 vs. $157,304, p < 0.01) in stroke patients. Late tracheostomy was associated with a 2.7-fold increase in reintubation risk (p = 0.02) and 40% lower likelihood of discharge to rehabilitation (p < 0.01). In non-stroke patients, late tracheostomy was linked to longer ICU LOS (35.5 vs. 22.1 days, p < 0.01), extended hospitalization (50.8 vs. 32 days, p < 0.01), and increased costs ($206,184 vs. $128,788, p < 0.01). Tracheostomy-related complications were more frequent in early tracheostomy stroke patients (22.1% vs. 7.3%, p = 0.03), but this did not impact overall discharge outcomes.</p><p><strong>Conclusions: </strong>Early tracheostomy in neurocritical patients, particularly those with stroke, is associated with shorter ICU stays, lower reintubation rates, and improved discharge to rehabilitation. While early tracheostomy carries a higher risk of procedural complications, its benefits in ICU efficiency and recovery support its role in evidence-based airway management strategies. Future prospective studies should focus on refining patient selection criteria for early tracheostomy and evaluating long-term functional outcomes in neurocritical care populations.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"2 1","pages":"56-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-Pocket Costs and Potential Surprise Bills for Tracheostomy in Commercially Insured Patients.","authors":"Nicholas R Lenze, Jasdeep S Kler, Chamila D Perera, Karan R Chhabra, David Goldenberg, Vinciya Pandian, Michael J Brenner","doi":"10.62905/001c.147777","DOIUrl":"10.62905/001c.147777","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheostomy involves complex, resource-intensive care. Yet, few data about the procedure-related cost burden for patients and their families are available. Passage of the No Surprises Act has been associated with changes in patient billing for certain healthcare services, but data on tracheostomy have not been investigated.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Merative MarketScan database for commercially insured patients aged 18-64 who underwent tracheostomy from 2014-2022 in the United States. We estimated out-of-pocket (OOP) costs (sum of deductibles, copay, and coinsurance) and potential surprise bills (an out-of-network claim where both the primary surgeon and facility were in-network) within 30 days of surgery. Relationships between OOP costs, potential surprise bills, and patient- and system-level exposures were analyzed.</p><p><strong>Results: </strong>Among 8,950 patients who underwent tracheostomy, the mean (SD) age was 49.3 (12.7) years; most patients were male (61.8%) and had fee-for-service based insurance (79.8%). The mean (SD) total OOP cost attributable to tracheostomy was $1,423 (2,029), and coinsurance accounted for 62.8% of these costs. Potential surprise bills were present in 9.1% of surgical episodes overall and were associated with higher OOP costs (mean (SD) $1909 (2433) vs. $1444 (2021); p<0.001)). High-deductible health plans and fee-for-service based plans were the largest predictors for overall OOP costs (cost ratio 2.66 and 1.84, respectively; p<0.001 for both) and potential surprise bills (odds ratio 2.07 and 2.78, respectively; p<0.001 for both). The incidence of potential surprise bills diminished over the course of the study period.</p><p><strong>Conclusions: </strong>Patients undergoing tracheostomy have significant exposure to OOP costs, predominantly attributable to coinsurance, with potential surprise bills representing an additional source of cost exposure. These findings highlight the need for financial counseling and policy reform to reduce patient cost burdens.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"2 3","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12782569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Policy and Equity in Tracheostomy Care: Navigating Access, Advocacy, and Reform.","authors":"Michael J Brenner, Vinciya Pandian","doi":"10.62905/001c.126409","DOIUrl":"10.62905/001c.126409","url":null,"abstract":"<p><p>The evolving U.S. healthcare landscape poses significant challenges for individuals requiring tracheostomy care, their families, and healthcare teams. These patients, their care partners, and health professionals face significant medical and social challenges, necessitating coordinated, long-term support to maintain health, prevent complications, and enhance quality of life. While policies like the Affordable Care Act (ACA) and Medicaid expansion have reduced uninsured rates and improved access to critical services, sustaining these gains relies on the renewal of subsidies that broaden coverage. Systemic barriers-including coverage gaps, inequities, and administrative inefficiencies-persist. This commentary explores how healthcare reforms, including Medicaid expansion, enhanced ACA subsidies, and Medicare policy adjustments, can address these barriers. It also highlights the disproportionate burden on low-income and minority populations, as well as the strain on healthcare teams managing complex care needs. Advocacy efforts should focus on expanding coverage, reducing costs, and addressing social determinants of health to promote equitable, high-quality care for all patients.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"1 3","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12841842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simulated Tracheostomy Tube Change Educational Intervention to Promote Competency Among Novice Healthcare Professionals: A Repeated Measures Study.","authors":"Jessica Peter, Chandler H Moser, Vidyadhari Karne, Stanola Stanley, Helen Wilson, Carol S Maragos, Jacqueline Stokes, Kathryn Mattare, Laurie Turner, Michael J Brenner, Vinciya Pandian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate an educational intervention to promote confidence, knowledge, and skills in tracheostomy tube change among nursing students.</p><p><strong>Methods: </strong>The study, conducted at the at the Johns Hopkins Center for Immersive Learning and Digital Innovation, enrolled nursing students without prior experience in tracheostomy tube change. The intervention included a pre-recorded presentation, faculty demonstrations with a Tracheostomy Care Training Simulation Model, and participant practice demonstrating skills. Primary outcomes included confidence, knowledge, and competency with tracheostomy tube changes. Secondary outcomes included number of attempts required to achieve competency and time required per attempt. The study followed STROBE guidelines with repeated measure design.</p><p><strong>Results: </strong>Participants in the study (n=50) had a mean age of 30 years, were predominantly female (83%) with a bachelor's degree (76%), most often in the third semester of nursing school (45%). Participants showed a mean improvement of 3.58 points out of five (SD: 0.56, P<0.001) across 11 pre- and post-test items. Every confidence assessment improved, with the largest increase in assessing tube placement. Knowledge assessments improved across all eight test items in the first test-retest interval, showing an improvement of 1.14 points out of five (SD: 0.89, P<0.001). Competency assessment improved in the first test-retest interval of 1.01 points out of five (SD: 0.65, P<0.001). On serial assessments, time to complete tracheostomy tube change decreased from 2.39 to 0.60 minutes. Faculty deemed 95% of participants competent after only one skill testing iteration.</p><p><strong>Conclusion: </strong>An educational intervention, combining digital presentations with interactive faculty-led simulations and practical skill assessments, successfully elevated nursing students' confidence, knowledge, and competency in tracheostomy tube changes.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"1 2","pages":"16-26"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevating Tracheostomy Care Through Data-Driven Innovation: What Can Education, Evidence-Based Practice, and Quality Improvement Learn from One Another?","authors":"Michael J Brenner, Vinciya Pandian","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The past decade has witnessed unprecedented progress in tracheostomy care, through communication, dissemination, and implementation of key drivers including interprofessional education, team-based care, standardized protocols, patient and family engagement, and data-driven practice. Improved safety, efficiency, and quality of tracheostomy care reflects contributions from fields of competency-based education, evidence-based practice, and quality improvement. These elements are interconnected, reinforcing one another to enhance patient care. Competency-based interactive education emphasizes active and practical learning through simulations and case studies, which enhance the clinical skills essential for high-quality care. These educational strategies are grounded in clinical research, ensuring that care practices are continually updated and aligned with the latest evidence, thereby bridging the gap between research findings and clinical application. Quality improvement processes such as Plan-Do-Study-Act (PDSA) cycles refine care delivery in real-world settings. Implementation science promotes the uptake of evidence-based practices, ensuring that discoveries translate to improved health outcomes, quality of care, and overall system performance. In each of these domains, patient and family engagement ensures alignment with patient needs and values. The Global Tracheostomy Collaborative leverages this integrated approach through international educational symposia and webinars, comprehensive data analyses, and a learning community that promotes innovative technologies like in situ simulation and augmented and virtual reality. Together, these approaches enhance the learning and application of best practices in tracheostomy care. The continuous, dynamic interaction of education, research, and quality improvement, grounded in patient-centered care, fosters excellence and innovation in care of patients with tracheostomy.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"1 2","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes.","authors":"Mary N Gentile, Annalise D Irvine, Annamarie M King, Achsha S Hembrom, Keven S Guruswamy, Nina E Palivela, Nicole Langton-Frost, Colleen R McElroy, Vinciya Pandian","doi":"10.62905/001c.115440","DOIUrl":"https://doi.org/10.62905/001c.115440","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation.</p><p><strong>Results: </strong>Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues.</p><p><strong>Conclusion: </strong>Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"1 1","pages":"26-41"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficult Airway Response Team Outcomes in an Academic Emergency Department: A Prospective, Multidisciplinary Airway Management Cohort Study.","authors":"Mustapha O Saheed, John Varghese, Dang Truong, Alexander T Hillel, Elliott R Haut, Lauren C Berkow, Thomas Kirsch, Michael J Brenner, Vinciya Pandian","doi":"10.62905/001c.126036","DOIUrl":"10.62905/001c.126036","url":null,"abstract":"<p><strong>Background: </strong>Successful first-attempt intubation minimizes the risk of hypoxemia, hypoventilation, and hypoperfusion. However, few data exist on outcomes of team-based difficult airway management in the Emergency Department (ED) for patients with deteriorating respiratory status.</p><p><strong>Objective: </strong>To investigate the outcomes of an ED Difficult Airway Response Team (DART) program.</p><p><strong>Methods: </strong>A prospective observational cohort study of DART implementation was conducted in the ED of an academic, tertiary care institution over a five-year period. An activation protocol was established, and the DART team included emergency physicians, other physicians (anesthesiologists, otolaryngologists, and trauma surgeons), respiratory therapists, nurses, and staff. Patients 18 years or older managed by the DART in the ED were included. Outcome measures included first-attempt intubation success, intubation techniques, and need for surgical airway.</p><p><strong>Results: </strong>Across 98 DART activations, 73 patients were managed in ED, nine patients were transported directly to the operating room, and 16 were transported to the operating room after an unsuccessful attempt at airway securement. Advanced airway techniques (fiberoptic bronchoscopy or videolaryngoscopy) accounted for 76% of first-attempt success with airway securement versus 24% for direct laryngoscopy (p<.01). Difficulty with bag-mask ventilation, need for cardiopulmonary resuscitation, and underlying illness predicted lower first attempt success rates (all p <.01). Surgical interventions were required in 17 patients, and 6 patients underwent cricothyroidotomy. There were no airway-related mortalities. Airway anatomy, difficult airway history, and context were associated with equipment selection, transport to operating room, and need for surgical airway.</p><p><strong>Conclusion: </strong>In this DART implementation, the first attempt intubation success was associated with use of advanced airway techniques and favorable patient characteristics.</p>","PeriodicalId":520079,"journal":{"name":"Tracheostomy (Warrenville, Ill.)","volume":"1 3","pages":"17-28"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}