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Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis
Chandler H Moser1, Anna Peeler2, Robert Long3
1Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Insights
Tracheostomy-related pressure injuries in critical care decreased by 79% with interventions like hydrophilic dressings and foam collars. Further research is needed to optimize prevention strategies for these common injuries.
Area of Science:
- Critical care medicine
- Patient safety
- Wound prevention
Background:
- Critically ill patients undergoing tracheostomy are at high risk for pressure injuries.
- Tracheostomy-related pressure injuries (TRPIs) commonly affect skin around the tracheostomy site and under fixation devices.
Approach:
- Systematic review and meta-analysis of 10 studies (pediatric and adult ICU patients).
- Evaluated interventions aimed at reducing TRPI incidence.
- Assessed study quality using Cochrane risk-of-bias criteria.
Key Points:
- Interventions reduced TRPI incidence by 79% (17.0% pre-intervention to 3.5% post-intervention).
- Effective interventions included foam collars, hydrophilic dressings under flanges, and extended tracheostomy tubes.
- Hydrophilic dressings under tracheostomy flanges showed a significant benefit in meta-analysis.
Conclusions:
- Hydrophilic dressings and foam collars are effective in decreasing TRPI incidence in critically ill patients.
- Limited evidence for individual interventions due to bundled approaches and measurement tool sensitivity.
- Further research is required to establish optimal TRPI prevention protocols.
Background:
In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries.
Objective:
To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting.
Methods:
MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration's risk-of-bias criteria.
Results:
Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury.
Conclusions:
Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.
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