Reducing Tracheostomy-Related Acquired Pressure Injury by Flipping the Ventilator Circuit Position Study

Area of Science:

• Critical Care Medicine
• Pulmonology
• Surgical Nursing

Background:

• Tracheostomy-related acquired pressure injuries (TRPIs) are a significant hospital-acquired condition.
• Uneven ventilator circuit load can cause non-neutral tracheostomy tube positioning, increasing TRPI risk.
• Standard post-tracheostomy care may not fully mitigate TRPI development.

Purpose of the Study:

• To evaluate if daily switching of ventilator circuit load reduces TRPI incidence.
• To assess the impact of the Flip the Ventilator Circuit (FLIC) protocol on TRPI rates.
• To determine the effectiveness of an intervention in preventing pressure injuries post-tracheostomy.

Main Methods:

• Prospective quality improvement study at two academic medical centers.
• Inclusion of consecutive patients undergoing percutaneous tracheostomy.
• Implementation of the FLIC protocol in intervention ICUs versus control ICUs.

Main Results:

• Overall TRPI incidence was 23% by post-tracheostomy day 5.
• The FLIC protocol group showed a significantly lower rate of skin breakdown (13% vs. 36%, p=0.01).
• Multivariable analysis indicated decreased odds of TRPI in the intervention group (OR 0.32, p=0.03).

Conclusions:

• The incidence of TRPIs within the first week post-percutaneous tracheostomy is notably high.
• Daily switching of ventilator circuit load may decrease the overall incidence of TRPIs.
• The FLIC protocol, combined with standard care, shows promise in reducing pressure injury development.