Background Tracheotomy is common in patients requiring long-term ventilation or neurological care. Managing these patients is challenging, as urgent cannula exchanges (CE) carry potentially life-threatening risks. To improve safety and standardize care, we implemented quality measures comprising a standardized bedside information sheet and mandatory staff training. This retrospective study evaluates their impact on complications in long-term tracheotomized patients. Methods A retrospective comparison study was conducted with the previous prospective cohort (pre) as a control and an intervention cohort (post) after implementing the stated quality measures. A chart review of adult tracheotomized patients treated between 2018 and 2020 in a 22-bed surgical ICU at a level 1 trauma center was performed. Each CE was documented with regard to its indications and complications, and descriptive and comparative analyses were performed. Results The study included 122 patients (pre: 49; post: 73). The post-group experienced fewer CEs per 100 days (2.65 vs. 4.58) and longer intervals between CEs (18 vs. seven days), with fewer planned exchanges. Although the post-group experienced higher tube occlusion and overall complications (pre 7.5% vs. post 8.5%), accidental decannulations were slightly lower. Respiratory complications were more common in the pre-group, while cardiocirculatory events predominated in the post-group. Conclusion Managing tracheotomized patients remains a significant clinical challenge. A standardized cannula information sheet and mandatory training may reduce the frequency of CEs and enhance patient safety.
Gerstmeyer et al. (Mon,) studied this question.