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Multidisciplinary team management of tracheostomy procedures in neurocritical care patients: our experience over 17 years in a quaternary centre

Published online by Cambridge University Press:  28 September 2021

F McClenaghan ,
S McGowan ,
L Platt ,
K Hunt  and
J Fishman
F McClenaghan*
Affiliation:
The Royal National Hospital for Neurology and Neurosurgery, London, UK The Royal National Throat, Nose and Ear Hospital, London, UK
S McGowan
Affiliation:
The Royal National Hospital for Neurology and Neurosurgery, London, UK
L Platt
Affiliation:
The Royal National Hospital for Neurology and Neurosurgery, London, UK
K Hunt
Affiliation:
The Royal National Throat, Nose and Ear Hospital, London, UK
J Fishman
Affiliation:
The Royal National Hospital for Neurology and Neurosurgery, London, UK The Royal National Throat, Nose and Ear Hospital, London, UK
*
Author for correspondence: Miss Fiona McClenaghan, The Royal National Hospital for Neurology and Neurosurgery, Queen's Square, LondonWC1N 3BG, UK E-mail: f.mcclenaghan@nhs.net
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Abstract

Objective

Tracheostomy in the neurocritical care population is associated with poorer outcomes. This study hypothesised that a multidisciplinary approach to tracheostomy care can improve outcomes.

Methods

This study was a prospective longitudinal study of all tracheostomised patients in the neurocritical care units of a quaternary centre over 17 years. All patients were managed by a tracheostomy team with a constant core membership of an intensive care consultant, speech and language therapist, and physiotherapist with consultant ENT input.

Results

A total of 51 per cent of patients were decannulated in hospital at an average of 48 (neuromedical) and 57.6 (neurosurgical) days. Of the 42 per cent of patients transferred to another facility with a tracheostomy tube in situ, 37.5 per cent were at an advanced stage of tracheostomy weaning. Complication rates were low at 4.8 per cent with no tracheostomy associated mortalities.

Conclusion

A multidisciplinary approach can enable good outcomes in the neurocritical care population. Consistency of care spanning the step-down from critical to ward-level care is crucial to improving outcomes.

Keywords

TracheostomyCritical CareNeurologyNeurosurgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 8 , August 2022 , pp. 703 - 712
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Miss F McClenaghan takes responsibility for the integrity of the content of the paper

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