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Updated: Jun 23, 2025

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
The NICU tracheostomy team: multidisciplinary collaboration for improvement in survival of complex patients
Joana Silva Machry1, Julia Krzyzewski2, Courtney Ward2
1Division of Neonatology, Maternal Fetal & Neonatal Institute at Johns Hopkins All Children's Hospital St. Petersburg, St. Petersburg, FL, USA. jmachry1@jhmi.edu.
Objective:
Evaluate feasibility and impact of "Tracheostomy Team" on survival and length of stay (LOS) at a level IV NICU.
Methods:
Plan-do-study-act cycles targeted five Global Tracheostomy Collaborative "key drivers". From January 2017 to December 2022 multidisciplinary, bimonthly bedside rounds were conducted.
Results:
After 3 cycles, in-hospital survival among 39 patients with tracheostomy improved and sustained from 67% to 100% (baseline 18/27; 66.7%; QI 35/39, 89.7%; p = 0.03). Median LOS (days [IQR]) did not significantly differ between baseline and QI (237 [57-308] vs. 217 [130-311]; p = 0.9). Among patients with BPD, median LOS was higher after QI interventions (baseline 248 [222-308] vs. QI 332.5 [283.5-392]; p = .02). Special cause variation resulted from peak increase in LOS during the COVID19 pandemic (2021). Tracheitis/pneumonia was treated significantly more frequently in QI BPD patients.
Conclusion:
Multidisciplinary approach is feasible, resulting in improved survival without a sustained increase in LOS. Future QI efforts should address post-operative infectious complications.
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