Improving Tracheostomy Decannulation Rate In Trauma Patients

Identify the effect of a multidisciplinary tracheostomy decannulation protocol (TDP) in the trauma population.

Single center retrospective review.

American College of Surgeons Level 1 Trauma Center; large academic associated community hospital.

Adult trauma patients who required a tracheostomy.

A TDP empowering respiratory therapists to move patients towards tracheostomy decannulation (TD).

TD rate, time to TD, length of stay, reintubation and recannulation rates.

A total of 252 patients met inclusion criteria during the study period with 134 presenting after the TDP was available. Since the TDP was implemented, patients managed by the TDP had a 50% higher chance of TD during the hospital stay (p<0.001). The time to TD was 1 day shorter with the TDP (p=0.54). There was no difference in time to discharge after ventilator liberation (p=0.91) or in discharge disposition (p=0.66). When comparing all patients, the development of a TDP, regardless if a patient was managed by the TDP, resulted in an 18% higher chance of TD (p=0.003). Time to TD was 5 days shorter in the post intervention period (p=0.07). There was no difference in discharge disposition (p=0.88) but the time to discharge after ventilator liberation was shorter post protocol initiation (p=0.04).

In a trauma population, implementation of a TDP significantly improves TD rates during the same hospital stay. A larger population will be required to identify patient predictive factors for earlier successful TD.