Volume 13 Issue 1 - 2020

Welcome to this special issue of the Otorhinolaryngologist devoted to tracheostomy care. Tracheostomy are inserted by surgeons (ENT or OMFS) and increasingly by intensive care physicians. Tracheostomy care, following insertion, traditionally has been provided by a number of medical (ITU, Respiratory, ENT, OMFS) and allied health care professionals (nurses, speech and language therapists, physiotherapists) individually rather than in a collaborative approach.

It has become more recognised in recent years that safe and optimal care for patients with a tracheostomy requires a multi-disciplinary approach requiring a range of health care professionals.

The Global Tracheostomy Collaboration has been instrumental in supporting and disseminating best practice from exemplar hospitals for adult and paediatric patients with a tracheostomy.

This special issue contains a range of abstracts presented at the 4th and 5th International Tracheostomy Symposium.

The benefits of standardised care and with a multi-disciplinary team to reduce harm is demonstrated in studies from the United Kingdom, Australia and Singapore.

Further abstracts from USA and Australia demonstrate the benefits of education for both healthcare professionals but importantly for family carers.

I hope that this issue stimulates further improvements to the care provided to adult and paediatric patients with a trachesotomy.

Ram Moorthy

Editor

The science of healthcare delivery is a young field, and when the inaugural International Tracheostomy Symposium (ITS) was convened in Melbourne, Australia in 2011, team-oriented approaches to tracheostomy were still in their infancy. While clinicians around the world had been witnessing how fragmented care predisposed to tracheostomy-related adverse events, there was little consensus on how fix the problem.

The last decade has witnessed unprecedented progress in our understanding and management of tracheostomy care. Beginning in 2011, several landmark studies and audits on tracheostomy-related harm became a clarion call for improving the prevailing standard of care. Data revealed that in intensive care units, tracheostomyrelated incidents accounted for up to half of all airway-related deaths and hypoxic brain injuries.

In the past 10 years, tracheostomy- related catastrophic events have galvanized the international community. The most startling realization in the wake of these findings was that most of these catastrophic events were preventable, arising from avoidable shortfalls in education, preventive, or rescue measures. The Global Tracheostomy Collaborative (GTC) emerged with a vision of safe tracheostomy care worldwide for patients through building a learning community that promoted key drivers of improved care. A cornerstone of this effort has been patientcentered multidisciplinary teams.

The use of fenestrated tracheostomy tubes is controversial. Advantages and disadvantages of fenestrated tracheostomy tubes must be explored and considered when clinically indicated. This systematic review provides insight into when fenestrated tracheostomy tubes should be considered and what safety measures must be in place.

This abstract describes an ongoing quality improvement initiative utilizing high fidelity simulation emergency training for family caregivers of tracheostomy and ventilator-dependent children. We have expanded simulation training for family caregivers of tracheostomy-dependent children without ventilator dependence and established a new standard of care for our Ventilator Care Program.

Hospital-based education programs for home respiratory care equipment using learner-centered, competency-based teaching methods thoroughly prepares caregivers of technology-dependent children.

Overnight polysomnography provides useful information in the liberation from respiratory technology process. Liberation from home mechanical ventilation and decannulation strategies vary due to lack of clinical practice standards. Our study aimed at evaluating our practice utilizing polysomnography in the liberation process in tracheostomized children with and without home mechanical ventilation.

Verbal communication affects patient autonomy. Communication is limited in intubated patients causing frustration. Our study aimed at evaluating the outcomes of patients using a talking tracheostomy. The goal is to promote communication between patients and healthcare providers in the ICU and evaluate the impact on quality of life.

Our study aimed to analyze insurance-related barriers patients face when attempting to receive medical care for their tracheostomy. The goal is to document the variability in coverage and information accessibility that patients face when trying to obtain health insurance.

Discussion of identified nutritional and feeding skill deficits of children with tracheostomy dependence.

Tracheostomy care in leading pediatric hospitals is both multi-disciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited  settings lacking developed healthcare infrastructure.

 Medical advances have led to an everincreasing use of tracheostomy in children requiring long-term ventilation. Children with a tracheostomy often have multiple comorbidities and require high-level integrated care to minimise complications. Healthcare professionals responsible for managing this vulnerable cohort must have sufficient expertise to do so effectively. This study aimed to evaluate the educational effectiveness of an interactive webinar lecture series designed for paediatric healthcare professionals.

Presentation of data before and after interventions to reduce tracheostomy pressure wounds following tracheotomy. Our institution was able to significantly reduce overall wounds and eliminate advanced stage wounds using a wound care protocol implemented by a multidisciplinary team.

Little data exists regarding use of tracheostomy ventilation (TV) in patients with motor neurone disease (PwMND). Some UK centres offer TV as a treatment option. It is hypothesised that starting TV in PwMND is intrusive to quality of life and leads to unacceptably, long hospital stays.

Skin complications are a common concern for tracheostomised patients. The tracheostomy team at Toronto Western Hospital performed a literature search to identify validated tracheostomy skin assessment and tracheostomy wound complication risk assessment tools. This search yielded no validated tools. We will discuss tools and plans to develop a validated instrument.

Stomal granulomas are a tracheostomy related post-operative complication that can result in bleeding as well as airway obstruction. The goal of this study is to evaluate the efficacy of topical treatment modalities in reducing stomal granulation tissue.

Project aims to identify and examine tracheostomy related return visits to hospital system. Hypothesized that there are frequent tracheostomy related returns, and that these are clustered close to time of initial discharge. Goal was to use information to generate targeted intervention prior to first discharge to decrease return rate.

The 2014 NCEPOD report illustrated a complication rate of 25.2% in a study of over 2,500 tracheostomy patients. Good quality care requires a team-based integrated practice from multiple healthcare professionals. The benefits of medical teaching using webinar software are becoming increasingly realised. Webinars are an accessible tool and are therefore uniquely placed to deliver interprofessional education.

Above Cuff Vocalisation involves passing retrograde gas flow via the subglottic suction port of standard tracheostomy tubes. We studied in detail the effectiveness and adverse effects of this underutilised technique in ten ventilator dependant critically ill patients.

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