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Introduction
Several tracheostomy clinical pathways and decannulation protocols have been proposed to optimize
tracheostomy care; however, no universally accepted method exists. This study aimed to examine
the characteristics of decannulated and non-decannulated subgroups to inform the development of
tracheostomy clinical pathways which reflect the routine model of care.
Methods
A retrospective observational cohort study design was employed to examine the clinical
characteristics of patients who were decannulated and non-decannulated between January 2015 and
December 2019. These data informed the development of two tracheostomy clinical pathways by an
experienced multi-disciplinary team.
Results
There were 440 tracheostomy admissions during the study period. Patients admitted with respiratory
(n = 100; 23%) or neurological conditions (n = 70; 16%) were most represented in the study sample.
Three-quarters of the cohort (n = 323; 73%) were decannulated before discharge or death. Survival to
hospital discharge was 90% overall (95% of those decannulated patients; 76% of non-decannulated
patients). Most were either discharged home (39%) or to an inpatient rehabilitation setting (37%). A
clinical pathway for the management of patients who are simple to wean from mechanical ventilation
(SW) was developed. A second clinical pathway for the management of patients who require
prolonged weaning from mechanical ventilation (PW) was developed with two tiers: 1) Unable to
wean from invasive mechanical ventilation (<4 hours continuously or no ventilator-free time) and 2)
Able to wean from invasive mechanical ventilation.
Discussion
Two tracheostomy clinical pathways were developed to reflect the multidisciplinary model of care
of a centre with mature tracheostomy and weaning unit teams, in order to standardize approaches to
rapid vs prolonged weaning from mechanical ventilation and tracheostomy decannulation. Robust
programs of research are needed to strengthen the evidence in tracheostomy care globally. Future
validation of these pathways is warranted. |
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