Dissertations / Theses: 'Tracheostomy'

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Onuoha, Joy. "Developing an Educational Program for Tracheostomy Care." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6934.

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Medical-surgical nurses at the project site demonstrated a knowledge deficit regarding the care of adult patients with a tracheostomy. Such knowledge deficits could expose patients to higher risks for infection, bedsores, prolonged hospital stays, increased costs, increased caregiver burden, and death. The purpose of this project was to develop an educational program to improve nurses' knowledge and confidence in the provision of evidence-based tracheostomy care to answer the question if the content of an evidence-based educational program developed to improve nurses' knowledge and confidence in managing adult patients with tracheostomy on a medical-surgical floor would meet the expectations of a panel of content experts. Bandura's self-efficacy and social learning theories provided theoretical guidance for the project. Five local nurse practitioners served as content experts and made recommendations about how the program could be improved, as well as suggestions relating to the wording of and the time allowed for the simulation aspect of the program. Content experts used a 5-point Likert-scale survey to evaluate the education at the completion of the program. Results showed that all reviewers strongly agreed that the content of the program was relevant, was based on the best available evidence, and was well organized and easy to follow. This project may promote positive change on the medical-surgical floor by improving providers' knowledge, skills, and confidence in the provision of care based on the best available evidence, which may lead to improvements in the quality of care provided to tracheostomized patients.

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Kostyliovienė, Silva. "Slaugytojų žinios ir įgūdžiai atliekant tracheostomos priežiūrą." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140711_084834-26889.

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Tracheostomos priežiūros veiksmai bei sekreto išsiurbimo iš tracheostominio vamzdelio technika gali įtakoti komplikacijų dažnumą ir lemti paciento saugumą, pasveikimo galimybę, gydymo trukmę bei gydymo kainą. Svarbu, kad slaugytojai žinotų mokslo tyrimais pagrįstas rekomendacijas apie tracheostomos priežiūrą ir jas pritaikytų klinikinėje praktikoje. Tyrimo tikslas – Išanalizuoti slaugytojų žinias ir įgūdžius atliekant tracheostomos priežiūrą. Tyrimo uždaviniai. 1.Ištirti slaugytojų žinias apie tracheostomos priežiūrą prieš ir po mokymų. 2. Nustatyti slaugytojų įgūdžius atliekant tracheostomos priežiūros veiksmus. 3. Palyginti slaugytojų žinias apie tracheostomos priežiūrą ir jų taikymą praktikoje. Tyrimo metodai: Tyrimas buvo vykdomas 2013.04.20–12.20 LSMUL Kauno Klinikų keturiuose skyriuose bei vienoje iš Slaugos ir palaikomojo gydymo ligoninių. Tyrimo duomenims rinkti buvo naudojamas tyrimo autorių sukurta anketa ir slaugytojų praktikinių veiksmų stebėjimo protokolas. Slaugytojų anketinė apklausa buvo vykdoma du kartus: prieš (n=90, atsako dažnis–96,77 proc.) ir po (n=86, atsako dažnis–92,47 proc.) mokymo. Stebėtos 99 sekreto išsiurbimo iš tracheostomos vamzdelio procedūros. Tyrimui atlikti buvo gautas LSMU Bioetikos centro pritarimas BEC-KS(M)-198. Išvados. 1. Prieš mokymus didžioji dalis slaugytojų teisingai žinojo požymius, rodančius siurbimo poreikį, sekreto išsiurbimo trukmę, kiek giliai įvesti atsiurbimo kateterį, galimas sekreto siurbimo komplikacijas. Po mokymo... [toliau žr. visą tekstą]
Actions of tracheostomy care as well as the technique of secretion suctioning from tracheostomy tube can influence the incidence of complications and determine patient‘s safety, possibility of recovery, the duration of treatment and the cost of treatment. It is critical for nurses to be aware of tracheostomy care recommendations based on scientific research and to apply them in clinical practice. The aim – to analyze nurses’ knowledge and skills in tracheostomy care. Objectives:1.To examine nurses’ knowledge on tracheostomy care prior to training and after the training. 2. To identify nurses’ skills while performing actions of tracheostomy care. 3. To compare nurses’ knowledge on tracheostomy care and their application in practice. Research methods: The research was conducted on 20-04-2013 - 20-12-2013 at the hospital of Lithuanian University of Health Sciences Kauno Klinikos in four departments and in one of the Nursing and supportive care hospital. A questionnaire created by the authors of the research and an observation protocol of nurses’ actions in practice was used to collect the data of the research. A survey on nurses’ was conducted twice: prior to training (n=90, response rate – 96.77%) and after the training (n=86, response rate – 92.47%). We observed 99 procedures of secretion suctioning from tracheostomy tube. The research was conducted with the approval BEC-KS (M)-198 from the center of Bioethics of Lithuanian University of Health Sciences. Conclusions. 1... [to full text]

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Ling, Cheuk-ki Cora, and 凌卓錡. "Predictors of swallowing outcome in patients with tracheostomy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206607.

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It is known that the incidence of aspiration is high in patients with tracheostomy. However, it is unclear which patient population with tracheostomy has a higher chance to aspirate. This study aims to determine the predictors of swallowing outcome of patients with tracheostomy. Eighty- three patients with tracheostomies who underwent videofloroscopy for swallowing were recruited in the study. Analysis was done on the presence of aspiration as well as the feeding status with respect to medical conditions and duration of tracheostomy. The prevalence of aspiration and silent aspiration were found to be high in patients with tracheostomy. The incidence of tube feeding was also found to be high in this patient population. Vocal cord paralysis was found to be a significant predictor of aspiration and silent aspiration in patients with tracheostomy. Head and neck cancer and vocal cord paralysis were found to be associated with tube feeding in patients with tracheostomy.
published_or_final_version
Surgery
Master
Master of Medical Sciences

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Björling, Gunilla. "Long-term tracheostomy : outcome, cannula care and material wear /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-261-3/.

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Potoshna, Lisa. "Design and Development of a Tracheostomy Tube Test Device." Thesis, KTH, Skolan för teknik och hälsa (STH), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-190478.

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In the NRC (National Respiratory Centre) department at Danderyds Hospital different standard tracheostomy tubes are customized in order to create a more appropriate fit for the individual patient. This master thesis aims to design a theoretical model and build a first prototype of a tracheostomy tube test device that can be used to analyse and compare the physiological performance of different for tracheostomy tubes. The theoretical model of the device consisted of an artificial lung, artificial trachea and a ventilator, pressure and flow sensors and a data acquisition device. The first prototype was built using equipment available at the NRC department and three experimental set-ups were assembled: one simulating normal breathing and two set-ups simulating coughing. Two artificial tracheas, a small and a large one together with different tracheostomy tubes were used to evaluate the first prototype. Results showed that the first prototype could be used to compare cuffed fenestrated and non-fenestrated tracheostomy tubes. However, the first prototype was less effective when comparing uncuffed fenestrated and non-fenestrated tracheostomy tubes, which is due to the lack of airway resistance in uncuffed tubes. Results strongly motivate a further development of the device with equipment described in the theoretical model and the future studies should be focused on improving the device.

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Dempsey, Ged. "Long term outcomes following percutaneous dilatational tracheostomy in the critically ill." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2052442/.

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Background: Percutaneous procedures are now the predominant tracheostomy technique within the critical care setting. Complication rates for various techniques appear to be equivalent to those achieved with surgical tracheostomy. There is a paucity of data when comparing percutaneous procedures, particularly when considering late complications (tracheo-innominate artery fistulae (TIF)), tracheooesophageal fistulae (TOF) and tracheal stenosis (TS). Given the severity of illness and associated mortality in many of these patients the incidence of these complications remains difficult to define. Confounding factors present in survivors of critical illness may present difficulties in diagnosis such that underlying tracheal pathology may go undiagnosed. Aims: To determine: The incidence of common early and late complications of percutaneous dilatational tracheostomy (PDT) in relation to surgical tracheostomy (ST). The role of peri-operative events that may contribute to the aetiology of late complications of TS, TIF and TOF. The incidence of early and late complications in relation to percutaneous tracheostomy to define the safest percutaneous technique. The utility of adjunctive techniques (bronchoscopy & ultrasound scanning) in reducing complications of PDT. The prevalence of sub-clinical TS following PDT using the single tapered dilator technique (STD). Aetiological factors for sub-clinical TS. Whether sub-clinical TS may present atypically in critical illness survivors. Methods: We have conducted a systematic review of all prospective studies reporting late complications after tracheostomy performed in the critically ill. We have also extracted data to assess the role of peri-operative events and monitoring in causing or preventing late complications. We have undertaken an eleven-year review of all PDTs performed within our unit to define the incidence of complications arising within our own population. Finally, a prospective study to identify the prevalence of sub-clinical TS and identify atypical presenting features in survivors of critical illness has been performed. Results: All surgical and percutaneous techniques are broadly similar in terms of early and late complications. There is a higher incidence of wound infection when comparing ST to the multiple dilator PDT. There are few studies assessing late complications between percutaneous techniques. The TS rate varies from 2.8 to 0.6% for ST and the STD technique respectively. Due to limited data we were unable to identify peri-operative events that may lead to late complications. There is a very low rate of complications attributed to the STD technique with only 9 significant late adverse events. The rate of sub-clinical TS is low with doubtful clinical significance. Conclusions: We have not found a significant difference in the incidence of TS between PDT and ST. Our pooled proportions meta-analysis may indicate a tendency toward a higher rate of stenosis for ST. The reported complication rates presented within our cohort study may indicate that the STD PDT is one of the safer techniques available. The rate of sub-clinical stenoses following STD PDT is low and of doubtful clinical significance. Further work is required to define the role for percutaneous tracheostomy outside the critical care setting and to gather qualitative data to assess the patient’s perception of tracheostomy in the critical care setting.

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Ruscher, Thomas Hall. "A Compact Ultrasonic Airflow Sensor for Clinical Monitoring of Pediatric Tracheostomy Patients." Thesis, Virginia Tech, 2013. http://hdl.handle.net/10919/50143.

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Infants and young children with tracheostomies need better respiratory monitors. Mucus in the tracheostomy tube presents a serious choking hazard. Current devices indirectly detect respiration, often yielding false or delayed alarms. A compact ultrasonic time-of-flight (TOF) airflow sensor capable of attaching directly to the tracheostomy tube has been developed to address this need. The ultrasonic flow sensing principle, also known as transit time ultrasound, is a robust method that correlates the timing of acoustic signals to velocity measurement. The compact prototype developed here can non-invasively measure all airflow into and out of a patient, so that breath interruption can easily be detected.

This paper concerns technical design of the sensor, including the transducers, analog/digital electronics, and embedded systems hardware/software integration. Inside the sensor\'s flow chamber, two piezoelectric transducers sequentially transmit and receive ping-like acoustic pulses propagating upstream and downstream of flow. A microcontroller orchestrates measurement cycles, which consist of the transmission, reception, and signal processing of each acoustic pulse. The velocity and direction of airflow influence transit time of the acoustic signals. Combining TOF measurements with the known geometry of the flow chamber, average air velocity and volumetric flow rate can be calculated. These principles have all been demonstrated successfully by the prototype sensor developed in this research.

Master of Science

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Freeman-Sanderson, Amy Louise. "Healthcare of voiceless patients: speech pathology intervention for tracheostomy patients in intensive care." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/14371.

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Voicelessness, which is an absence of voice or sound, is a sequela of tracheostomy tube insertion and inflation of the tracheostomy cuff. Air is diverted from the larynx and prevents the generation of voice. Voicel Voicelessness, which is an absence of voice or sound, is a sequela of tracheostomy tube insertion and inflation of the tracheostomy cuff. Air is diverted from the larynx and prevents the generation of voice. Voicelessness in such circumstances is not identified within a patient’s medical record as a specific medical diagnostic code in Australia and therefore its incidence, and any episodes of treatment are not accurately measured, costed or reported. Patients admitted to the intensive care unit experience loss of voice from placement of a tracheostomy tube every day. Over 160,000 patient admissions per year are recorded in Australian and New Zealand Intensive care units (ICU) with 39.1% of these admissions requiring invasive mechanical ventilation (ANZICS, 2014). Approximately 24 % of ventilated patients will require mechanical ventilation via a tracheostomy (Esteban et al., 2000) and many patients are likely to experience a long period of voicelessness as a result. Absence of voice to communicate has been described by patients as stressful, frustrating, isolating and one of the worst parts of their hospital admission. Without a voice, patients can experience reduced level of participation, lack of choice and decision making in their own healthcare. Restoration of voice is one of the primary aims of speech pathologists treating tracheostomy patients. Speech Pathology intervention is aimed at assisting the patient to progress along the tracheostomy weaning pathway; a process that includes cuff deflation and facilitation of phonation through use of speaking valves. There is a paucity of evidence-based literature describing the timing of intervention for phonation, with the majority of papers consisting of case studies. There have been no randomised control trials published on the type or timing of speech pathology intervention. Currently, access to early speech pathology intervention for phonation during mechanical ventilation is not standard practice in Australia. Knowledge of the effectiveness of early versus standard timing of speech pathology intervention to restore phonation, improve clinical outcomes and improve patient reported health quality of life is unknown and not documented in the published literature. This thesis details the definition of standard care via a retrospective file audit of tracheostomy patients admitted to the intensive care unit of a tertiary Australian hospital over a 12 month period, which is presented as a published paper (Chapter 2). Results showed that the median period of time patients were without voice during tracheostomy placement was 12 days with a range of 1-103 days. This finding contributed to the development of the remaining studies in this thesis, which aimed to evaluate the effectiveness of early Speech Pathology intervention for restoration of phonation during mechanical ventilation. This was investigated within a randomised control trial of standard versus Early Speech Pathology Review and Intervention for Tracheostomy patients in intensive care early versus standard Speech Pathology Intervention (ESPRIT). The specific research questions investigated were: 1. Does targeted early communication intervention for the restoration of voice in ventilated tracheostomy patients in the ICU improve time to phonation and verbal communication compared with standard care? 2. Does this early intervention decrease the duration of tracheostomy cannulation, duration of mechanical ventilation, length of ICU or hospital stay, and time to oral intake? 3. Is this early intervention safe? 4. Does this early intervention change patient reported quality of life scores? Thirty participants were enrolled and completed the trial. The primary outcome – return to voice – was significantly hastened in the early intervention group. Secondary outcomes reported include patient safety (including adverse events), mechanical ventilation and tracheostomy cannulation time, length of stay, time to oral intake, patient reported self-esteem of communication and general quality of life. The results of this trial led to two submitted publications with report of the quantitative findings from the RCT reported in Chapter 4 and the report of self-esteem related to communication and general quality of life provided in Chapter 5. Finally, the lived experience of voicelessness was further investigated in a multiple methods study conducted 6-months after tracheostomy tube decannulation (Chapter 6). This was investigated by thematic analysis of semi-structured in-depth interviews and use of validated self-esteem and quality of life outcome measures. There were four major themes identified by patients during the experience of voicelessness, which centre on patient awareness of their clinical situation; communication without voice; emotions experienced with voice loss; and level of participation and recovery. These are presented in a publication intended for submission. The publications arising from this thesis inform standard care for tracheostomy patients, compare timing and type of intervention for return of voice and examine the impact on patients, their experiences and participation within the ICU setting when voiceless. This thesis reports on the initial randomised controlled trial for return of voice for tracheostomy patients, and advocates the role of early Speech Pathology intervention within the ICU. Restoration of voice and effective communication is important in facilitating timely care and allows increased patient participation within the healthcare system. Ongoing research and enhancement of communication function for tracheostomy patients would only further a positive patient experience and ensure ongoing monitoring of safety parameters.

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Ramakrishnan, Vijaya. "Use of Simulation for Tracheostomy Care, a Low Volume, High Risk Nursing Procedure." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4981.

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Often, education regarding low volume and high-risk procedures, like tracheostomy, are ignored. Lack of experience, skills, and human resources can lead to decreases in confidence levels, diminished quality of care, and potentially an adverse event. The purpose of this DNP project was to prepare simulation-based education on the tracheostomy procedure and provide hands-on education to bedside nurses. The project answered the question: To what extent will a simulation-based teaching method adequately prepare staff nurses in a post-acute surgical unit to perform this high risk low volume procedure? The Johns Hopkins evidence-based model method was used to assist in translation of the practice change process. The International Nursing Association for Clinical Simulation and Learning standards were used to design simulation scenarios. Surgical acute care nurses (n = 35) including day and night shift nurses, new graduates, and experienced nurses participated. Groups of five to eight nurses participated in a two-hour simulation session at hospital simulation center. Pre- and post-surveys on confidence level data, and National League of Nursing evaluation tool data on educational practices and simulation designs were collected from all participants. Paired t-test statistics showed a significant increase in confidence level from pre to post education (p < .001). Because of the significant impact on patient care due to preventing complications and by improving nursing staff's level of confidence, the project may contribute to positive social change.

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Seljegard, Yuka K. "The effect of long-term tracheostomy on language and social development of young children." Thesis, University of Oxford, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.543585.

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McHenry, Kristen L. "A Study of the Relationship between APACHE II Scores and the Need for Tracheostomy." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2545.

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Wang, Tongyao. "Pictographic Education Handout: Significant Impact on Patients and Family Caregivers' Self-Efficacy on Tracheostomy Care." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case161945406039485.

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13

Bugis, Alaa Ahmed. "The Effect of Different Interfaces on Aerosol Delivery in Simulated Spontaneously Breathing Adult with Tracheostomy." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/rt_theses/9.

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Background: The delivery of an aerosol via a tracheostomy tube has been previously described with both a tracheostomy collar and a T-piece, but not with a Wright mask, or aerosol mask. The primary purpose of this study was to quantify lung doses using different interfaces: tracheostomy collar, Wright mask, and aerosol mask. The secondary purposes were to compare albuterol delivery between an opened vs. a closed fenestration hole and also to determine the effect of inspiratory time:expiratory time (I:E) ratio on aerosol delivery. Methods: A teaching mannequin (Medical Plastic Labs, Gatesville, TX) with a tracheostomy opening was used. Two of the mannequin's bronchi were connected to a "Y" adaptor, which was attached to a collecting filter (Respirgard ™ II 303, Vital Signs, Englewood, CO), which was connected to a breathing simulator (Harvard Apparatus Dual Phase Control Respirator Pump, Holliston, MA) through a corrugated tube. Settings for spontaneous breathing were respiratory rate 20/min, and tidal volume 400 mL. The I:E ratios were adjusted in the first and second comparisons at 2:1 and 1:2, respectively. The nebulizer was operated by a flow meter (Timemeter, St. Louis, MO) at 8 L/min with 100% oxygen. In every condition, the flow was discontinued at the end of nebulization. The nebulizer was attached to the tracheostomy collar (AirLife™, Cardinal Health, McGaw Park, IL) in the first group, the Wright mask (Wright Solutions LLC, Marathon, FL) in the second group, and the aerosol mask (AirLife™, Cardinal Health, McGaw, IL) in the third group. Drug was eluted from the filter and analyzed by spectrophotometry (276 nm). Data Analysis: Paired t-test, one-way analysis of variance (ANOVA), repeated measures ANOVA, post-hoc and pairwise comparisons were performed at the significance level of .05, using PASW version 18.0. Results: Aerosol delivery was greater with the tracheostomy collar than the Wright mask and aerosol mask (p < .05). Closing the fenestration hole increased aerosol deposition significantly at 2:1 ratio (p = .04) compared to opening the fenestration at 1:2 ratio. I:E ratio and aerosol delivery were directly related. Increasing I:E ratio from 1:2 to 2:1 improved aerosol delivery significantly with tracheostomy collar-fenestration opened (p = .009), Wright mask (p = .02) and aerosol mask (p = .01). Conclusion: This study indicates that the use of a tracheostomy collar is the best method of delivering aerosol therapy among the three interfaces. The I:E ratio of 2:1 caused greater aerosol deposition than 1:2 ratio. The aerosol deposition was better when the fenestration hole was closed compared with opened fenestration.

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McHenry, Kristen L., Randy L. Byington, Ester L. Verhovsek, and S. Keene. "A Study of the Relationship between APACHE II Scores and the Need for a Tracheostomy." Digital Commons @ East Tennessee State University, 2014. http://ispub.com/IJWH/9/1/14799.

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The purpose of this research was to determine if significant differences exist between the APACHE II scores of intubated mechanically ventilated patients who ultimately received a tracheostomy and those who did not. In addition to this inquiry, the study also investigated the possibility of a range of APACHE II scores, a particular age group, and the presence of chronic organ insufficiencies and their relationship to the tracheostomy result. Methodology was non-experimental, quantitative, and retrospective. It was observational in that the goal was to simply record and quantify the potential association between these variables. Data was obtained from patients at Bristol Regional Medical Center from January 1- August 31, 2011. Information was calculated using descriptive statistics and the t-test for independent samples. Participants included all intubated mechanically ventilated patients who were at least eighteen years of age with a documented APACHE II score in the allotted time frame. There were 468 total patients, 79 (16.9%) of which received a tracheostomy. The mean APACHE II score for patients who received a tracheostomy was 21.8354 as compared to the mean APACHE II score of 21.6735 for those who were extubated. There was no significant difference between the APACHE II scores of these groups. The tracheostomy group had the highest frequency of patients with APACHE II scores of less than 25 and a range of 20-29. 84.8% of tracheostomy patients had some form of chronic organ dysfunction. Respiratory failure was the most frequent admitting diagnosis for all 468 patients and respiratory insufficiency was the most prevalent co-morbidity for the tracheostomy patients. The age range that included more tracheostomy patients was 65-74. 40% of re-intubated patients eventually received a tracheostomy and 69.6% of tracheostomy patients had the procedure performed early (within the first seven days of intubation). The managerial team of this respiratory therapy department decided to stop calculating the APACHE II score on all intubated patients in an attempt to save time and staff resources.

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Crosby, William. "An evaluation of tracheostomy care anxiety relief through education and support (t-cares) a pilot study." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1530.

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Background: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver anxiety and tracheostomy suctioning competency. Method: A quasi-experimental non-randomized control group design was used. The independent variable was method of instruction (T-CARES versus standard). Dependent variables were caregiver anxiety and tracheostomy suction competence. Caregivers (n=12) self selected into groups based on availability to attend T-CARES course. The control group was to receive the unit-based standard of education. The experimental group participated in the T-CARES course. Only one person chose to be in the control group; therefore, data were analyzed for the experimental group only (N=11). The T-CARES course, created by the researcher, was standardized and instructor-led; it incorporated media and simulated practice. Caregiver anxiety for both groups was obtained before (State/Trait Anxiety) and after (State Anxiety) tracheostomy care instruction was provided. Tracheostomy suctioning competence was assessed using a standardized checklist for participants in the T-CARES study group only. Demographic data were summarized with frequencies and descriptive statistics. Given the small sample size, non-parametric statistics were used for data analysis. Results: Data were analyzed from the experimental group only (n=11). The majority of caregivers were women (n=7), white/caucasian (n=10), married (n=8), employed full time (n=7), and were high school graduates or higher (n=10). The mean age of participants was 50.8 years.; Seven of the participants reported previous caregiver experience. Mean score of caregiver trait anxiety was 36.8. Mean caregiver state anxiety score was 50.5 before, and 34.3 after the T-CARES intervention. A Related-Samples Wilcoxon Signed Rank Test was performed on the pre and post T-CARES intervention state anxiety scores. The T-CARES intervention significantly reduced anxiety (p=.008). Tracheostomy suctioning competency for 9 of the participants was evaluated upon completion of T-CARES. Mean score was10.8 skills performed correctly out of a possible 14. Caregivers' responses regarding their biggest fear/concern about tracheostomy care included "not doing it right," "trach coming out or being blocked," "hurting the patient," and "not being able to help in an emergency." Participants' suggestions for future improvements were creation of a Spanish language course and the addition of supplementary training to include CPR, First Aid, and the management of feeding tubes. Discussion: Research supported the hypothesis that the T-CARES course would be successful in reducing state anxiety. The T-CARES course also had a positive impact on tracheostomy suctioning competency, though without a control group it is difficult to quantify the effect. The continued development and dissemination of T-CARES to all tracheostomy patients and their caregivers may ease their transition home. The views expressed are those of the author and do not reflect the official policy or position of the US Air Force, Department of Defense or the US Government.
ID: 031908437; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Accepted in partial fulfillment of the requirements for honors in the major in DEPT HERE.; Thesis (B.A.)--University of Central Florida, 2012.; Includes bibliographical references.
B.S.N.
Bachelors
Nursing
Nursing

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Spratling, Regena. "The Experiences of Medically Fragile Adolescents Who Require Respiratory Assistance." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/nursing_diss/13.

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The population of medically fragile adolescents has grown in recent decades because of the sequelae of prematurity, injuries, and chronic or terminal illnesses. Medically fragile adolescents who require respiratory assistance are part of this unique population with challenges in their daily lives, yet as nurses, we know little about their experiences and the best approaches to use in caring for them. The purpose of this study was to explore the experiences of medically fragile adolescents who require respiratory assistance. Interpretive phenomenology was used to describe and interpret the experience of 11 medically fragile adolescents who required respiratory assistance. The adolescents ranged in age from 13 to 18 years of age and required respiratory assistances of tracheostomies, ventilator support, and Bi-level positive airway pressure (BiPap). Audiotaped semi-structured interviews were conducted with the adolescents. Data analysis was completed using the steps delineated by Diekelmann and Allen (1989). Six themes and one pattern were identified from the interviews with the adolescents. The major themes were “Get to know me”, “Allow me to be myself”, “Being there for me”, “No matter what, technology helps”, “I am an independent person”, and “The only one I know of”. This study explored medically fragile adolescents who required a specific technology, respiratory assistance, within a distinct developmental stage. These adolescents have a clear view of who they are as a person. They want nurses to view them as a person, not just a patient. The adolescents felt that friends were there for them when they needed support. This was in contrast to those that they did not consider friends who were judgmental. Technology had meanings that encompassed enhanced daily living and existing as a part of their day, not their whole day. The adolescents viewed themselves as an independent person and were actively engaging in activities and strategies to achieve their goals of independence. This study contributes to nursing knowledge by helping nurses to understand what these adolescents experience in their daily lives and aiding nurses in providing better care for these adolescents. Recommendations for nursing practice, education, and research were identified in this study.

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Alhamad, Bshayer R. "The Effect of Aerosol Devices and Administration Techniques on Drug Delivery in a Simulated Spontaneously Breathing Pediatric Model with a Tracheostomy." Digital Archive @ GSU, 2013. http://digitalarchive.gsu.edu/rt_theses/17.

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Background: Evidence on aerosol delivery via tracheostomy is lacking. The purpose of this study was to evaluate the effect of aerosol device and administration technique on drug delivery in a simulated spontaneously breathing pediatric model with tracheostomy. Methods: Delivery efficiencies during spontaneous breathing with assisted and unassisted administration techniques were compared using the jet nebulizer (JN- MicroMist), vibrating mesh nebulizer (VMN- Aeroneb Solo) and pressurized metered-dose inhaler (pMDI- ProAirHFA). The direct administration of aerosols in spontaneously breathing patients (unassisted technique) was compared to administration of aerosol therapy via a manual resuscitation bag (assisted technique) attached to the aerosol delivery device and synchronized with inspiration. An in-vitro lung model consisted of an uncuffed tracheostomy tube (4.5 mmID) was attached to a collecting filter (Respirgard) which was connected to a dual-chamber test lung (TTL) and a ventilator (Hamilton). The breathing parameters of a 2 years-old child were set at an RR of 25 breaths/min, a Vt of 150 mL, a Ti of 0.8 sec and PIF of 20 L/min. Albuterol sulfate was administered with each nebulizer (2.5 mg/3 ml) and pMDI with spacer (4 puffs, 108 µg/puff). Each aerosol device was tested five times with both administration techniques (n=5). Drug collected on the filter was eluted with 0.1 N HCl and analyzed via spectrophotometry. Results: The amount of aerosol deposited in the filter was quantified and expressed as inhaled mass and inhaled mass percent. The pMDI with spacer had the highest inhaled mass percent, while the VMN had the highest inhaled mass. The results of this study also found that JN had the least efficient aerosol device used in this study. The trend of higher deposition with unassisted versus assisted administration of aerosol was not significant (p>0.05). Conclusions: Drug deposited distal to the tracheostomy tube with JN was lesser than either VMN or pMDI. Delivery efficiency was similar with unassisted and assisted aerosol administration technique in this in vitro pediatric model.

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Hart, Catherine K. "Health-related Quality of Life in Children with Aerodigestive Disorders." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin151091845523319.

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Червань, И. В. "Рубцовый стеноз гортани и трахеи, как постреанимационное осложнение." Thesis, Сумский государственный университет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/42030.

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На сегодняшний день весьма актуальными вопросами остаются вопросы длительной интубации трахеи и способы ее реализации. Отсутствуют четкие параметры места и времени наложения трахеостомии. А возникающие постреанимационные рубцовые стенозы гортани и трахеи- до сих пор сложная и нерешенная проблема оториноларингологии.

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McGrath, Brendan Anthony. "Advances in multidisciplinary tracheostomy care and their impact on the safety and quality of care in the critically ill." Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/620231/.

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Tracheostomy is one of the first recorded surgical procedures and refers to an incision into the windpipe at the front of the neck, classically performed by surgeons to relieve airway obstruction. A tracheostomy tube can be inserted to maintain airway patency. The majority of tracheostomies are now performed the critically ill, typically whilst dependent on invasive respiratory support. Analysis of tracheostomy-related critical incidents helped to understand the frequency, nature and severity of problems that can occur at initial placement or during subsequent use. If problems occur, significant harm may rapidly develop, especially in the critically ill. Recurrent themes that contributed to avoidable mortality include poor emergency management and limitations in infrastructure, equipment provision, staff training and education. Many of the problems identified are amenable to prospective, multidisciplinary quality improvement strategies. This thesis describes my published work in this area. An underlying challenge to improving care lies in the fact that care requires input from many clinical disciplines. Complex patients need care in specialised settings that are not always adequately trained and supported in delivering safe tracheostomy care. My research has evaluated the impact of a co-ordinated multidisciplinary approach using bespoke resources, staff education, infrastructure changes and patient champions to direct healthcare improvements. I have critically appraised my bespoke resources and evaluated and justified the use of a variety of quality and safety metrics to define better care, both at patient-level and using institutional process measures, reflecting better coordination of care, contributing to significant cost savings. Further opportunities to build understanding of the nature of tracheostomy problems in ICU and the success of quality improvement initiatives will be discussed. Future aims are to not only improve care but also to perform a detailed economic analysis and capture knowledge on how to best implement necessary changes rapidly in today’s complex NHS.

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Gobatto, Andre Luiz Nunes. "Avaliação da traqueostomia percutânea guiada por ultrassonografia quando comparada à traqueostomia percutânea guiada por broncoscopia." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-28032018-113400/.

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A traqueostomia percutânea é um procedimento realizado rotineiramente na Unidade de Terapia Intensiva (UTI), guiada por broncoscopia. Recentemente, a ultrassonografia tem surgido como uma ferramenta potencialmente útil para assistir à traqueostomia percutânea e reduzir as complicações relacionadas ao procedimento. Um ensaio clínico randomizado, aberto, paralelo, de não inferioridade, foi conduzido comparando a traqueostomia percutânea guiada por ultrassonografia com a traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI. O desfecho primário, a falência do procedimento, foi definido como um desfecho composto, incluindo (1) a conversão para traqueostomia cirúrgica, (2) o uso associado e não planejado da broncoscopia ou da ultrassonografia, ou (3) a ocorrência de uma complicação maior. Um total de 4.965 pacientes foram avaliados quanto a elegibilidade. Desses, 171 pacientes foram elegíveis e 118 foram submetidos ao procedimento, com 60 pacientes randomizados para o grupo ultrassonografia e 58 pacientes randomizados para o grupo broncoscopia. A falência do procedimento ocorreu em um (1,7%) paciente no grupo ultrassonografia e um (1,7%) paciente no grupo broncoscopia, sem diferença no risco absoluto entre os grupos (intervalo de confiança de 90%, -5,57 a 5,85), na análise \"conforme tratados\", não incluindo a margem de não inferioridade pré-especificada de 6%. Nenhum outro paciente apresentou uma complicação maior em ambos os grupos. As complicações menores relacionadas ao procedimento ocorreram em 20 (33,3%) pacientes no grupo ultrassonografia e em 12 (20,7%) pacientes no grupo broncoscopia, (P = 0,122). A duração do procedimento foi de 11 [7-19] vs. 13 [8-20] minutos (P = 0,468), respectivamente, e os desfechos clínicos também não foram diferentes entre os grupos. Em conclusão, a traqueostomia percutânea guiada por ultrassonografia é eficiente, segura e associada com taxas de complicações semelhantes à traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI
Percutaneous Dilational Tracheostomy (PDT) is routinely performed in the intensive care unit (ICU) with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool in order to assist PDT and reduce procedure-related complications. An open-label, parallel, non-inferiority, randomized controlled trial was conducted comparing the ultrasound-guided PDT with the bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy; unplanned associated use of bronchoscopy or ultrasound during PDT; or the occurrence of a major complication. A total of 4,965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7%) patient in the ultrasound group and one (1.7%) patient in the bronchoscopy group, with no absolute risk difference between the groups (90% confidence interval, -5.57 to 5.85), in the \'as treated\' analysis, not including the pre-specified margin of 6% for noninferiority. No other patient had any major complication in both of the groups. Procedure-related minor complications occurred in 20 (33.3%) patients in the ultrasound group and in 12 (20.7%) patients in the bronchoscopy group, (P=0.122). The median procedure length was 11 [7-19] vs. 13 [8-20] minutes (P=0.468), respectively, and the clinical outcomes were also not different between the groups. In conclusion, ultrasound-guided PDT is effective, safe and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided tracheostomy in mechanically ventilated critically ill patients

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Engberg, Pramling Vilgot, and Melinda Kåhlin. "Patientens upplevelse av omvårdnaden kring sin trakeostomi." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-38765.

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Bakgrund: Trakeostomi erhålls av patienter som behöver en fri luftväg, både i akut skede och under en längre tid. Trots att trakeostomin är en viktig livsuppehållande åtgärd, medföljer risker. Kommunikation ligger till grund för god personcentrerad omvårdnad, som är en av sjuksköterskans kärnkompetenser. Personcentrerad omvårdnad lyfter fram patientens styrkor, tillgångar och involverar personen i sin omvårdnad. Syfte: Syftet var att undersöka patientens upplevelse av omvårdnad kring sin trakeostomi. Metod: En allmän litteraturstudie genomfördes i databaserna CINAHL, PubMed och Psycinfo. Resultat: Att ha en trakeostomi uppfattades som en känslomässigt påfrestande upplevelse. Trakeostomin påverkade patientens förmåga att kunna tala, vilket uppfattades som fysiskt och psykiskt påfrestande. Behovet av innehållsrik information, tålamod och närvaro från sjuksköterskan var viktiga delar för att skapa trygghet och lugn hos patienten. Att involvera patienten i sin omvårdnad medförde gynnsamma förutsättningar för den personcentrerade omvårdnaden och skapade tillit i vårdrelationen. Slutsats: Föreliggande studie visar att trakeostomerade patienter upplevde obehag som kunde förebyggas genom personcentrerad omvårdnad. Personcentrerad vård uppnåddes när patienten involverades, fick innehållsrik information och gavs tålamod i den icke-verbala kommunikationen.
Background: The tracheostomy enables a clear airway for those who need it, both in emergent situations and when needed for a longer time. Although this is a lifeprolonging intervention, tracheostomy is accompanied with risks. Communication has a pivotal role for person centered care, which is one of the nurse’s core competence. Person centered care highlight the patient’s strengths, assets and involves the patient in their care. Aim: Hence the aim of this study was to analyze the patient’s experience of their nursing care around the tracheostomy. Method: A general literature study was conducted in the databases CINAHL, PubMed and Psycinfo. Results: The tracheostomy was perceived as emotionally challenging. The tracheostomy affected the patient’s ability to speak, which was physically and mentally challenging for the patient. The need for comprehensive information and patience from the nurse was important to create a sense of security and calmness in the patients. To involve the patient in their care brought favorable conditions for the person centered care and created trust in the nurse. Conclusions: This study shows that tracheostomized patients experience discomfort that can be prevented by person-centered care, comprehensive information and having patience during the non-verbal communication with the patient.

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Karlea, Audrey. "Cost Analysis of Mandibular Distraction Versus Tracheostomy for Infants with Pierre Robin Sequence and Upper Airway Obstruction: A One-Year Analysis." Cincinnati, Ohio : University of Cincinnati, 2007. http://rave.ohiolink.edu/etdc/view.cgi?acc_num=ucin1179503013.

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Thesis (M.S.)--University of Cincinnati, 2007.
Advisor: Dr. Robert Hopkin. Title from electronic thesis title page (viewed June 30, 2010). Includes abstract. Keywords: Pierre Robin Sequence; Mandibular Distraction; Tracheostomy; cost; infant. Includes bibliographical references.

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Pasini, Renata Lenize. "A influencia da traqueostomia no tempo de ventilação mecanica, internação hospitalar e incidencia de pneumonia em pacientes com traumatismo craniencefalico." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312308.

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Orientador: Yvens Barbosa Fernandes, Sebastião Araujo
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-08T19:37:05Z (GMT). No. of bitstreams: 1 Pasini_RenataLenize_M.pdf: 1921410 bytes, checksum: 17bcb0d3a217f0284da26d92e3b8a5da (MD5) Previous issue date: 2007
Resumo: A traqueostomia é um procedimento comumente realizado em pacientes dependentes da ventilação mecânica (VM), internados em Unidade de Terapia Intensiva (UTI). Alguns autores acreditam que a realização precoce desse procedimento em tais pacientes diminui o tempo de dependência do aparelho ventilatório, bem como apresenta outros benefícios associados. Entretanto, o período mais adequado para a realização do procedimento ainda não se encontra bem estabelecido para pacientes com traumatismo craniencefálico (TCE), o que justificou a realização do presente estudo, cujo objetivo foi avaliar a influência da traqueostomia no tempo de ventilação mecânica e tempo de internação hospitalar de pacientes com TCE. Foi realizado um estudo prospectivo e não intervencionista, em que foram avaliados 33 pacientes com TCE de moderado a grave, cuja pontuação na escala de coma de Glasgow (ECG) foi = 10, com idade entre 14 e 80 anos e necessidade de traqueostomia. Os pacientes foram distribuídos em três grupos determinados a partir do momento da realização da traqueostomia: traqueostomia precoce (TP), realizada até o 6º dia de VM; traqueostomia intermediária (TI), realizada entre o 7° e 11° dias de VM; e a traqueostomia tardia (TT), realizada após o 12° dia de VM. Dos 33 pacientes avaliados, 28 eram do sexo masculino, com idade média de 30,7 ± 14,0 anos para a TP; 39,0 ± 18,4 anos para a TI e 37,7 ± 18,4 anos para a TT. No grupo submetido à traqueostomia precoce houve redução do tempo de ventilação mecânica e tendência a uma diminuição do tempo de internação hospitalar. O momento de realização da traqueostomia não influenciou na incidência de infecção pulmonar e mortalidade
Abstract: Tracheostomy has been performed frequently in ventilator-dependent patients in intensive care unit (ICU). Some authors believe that early tracheostomy can reduce mechanical ventilation (MV) time and can provide other associated benefits. However, its influence on weaning from MV is not clear in pacients with traumatic brain injury (TBI). The aim of this study was to evaluate the influence of tracheostomy on MV weaning in TBI patients. It was a prospective and non interventional study; including 33 patients with TBI (GCS < 10), aging between 14 and 80 years and that were submitted to a tracheostomy. The patients had been distributed into three groups: early tracheostomy (ET) (performed until 6th day of MV); intermediate tracheostomy (IT) (performed from the 7th to 11th day of MV) and late tracheostomy (LT) (performed after the 12th day of MV). Of the 33 evaluated patients, 28 were male and 5 female, aging 30.7 ± 14.0 years in ET group; 39.0 ± 18.4 years in IT group; and 37.7 ± 18.4 years in LT group. In the ET group, those patients with lower GCS and higher APACHE II at admission have shown a lesser hospital length of stay (HLOS); the IT group has shown a lesser HLOS in younger individuals and with lower APACHE II values. Regarding total MV time (orotracheal tube + tracheostomy), ET group has shown a lesser average time in relation to the other groups. However weaning times with tracheostomy alone were not different between groups. Also, pulmonary infection incidences have not been different between groups. Early tracheostomy can reduce total MV time and HLOS in patients with severe TBI, but it appears to have no influence on weaning time, incidence of pulmonary infection and mortality
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas

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Frank, Ulrike. "Die Behandlung tracheotomierter Patienten mit schwerer Dysphagie : eine explorative Studie zur Evaluation eines interdisziplinären Interventionsansatzes." Phd thesis, Universität Potsdam, 2008. http://opus.kobv.de/ubp/volltexte/2008/2016/.

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In der neurologischen Rehabilitation werden in zunehmendem Maße tracheotomierte Patienten mit schweren Dysphagien behandelt. Daher sollte den hierzu bisher entwickelten Interventionsverfahren eine evidenzbasierte Grundlage gegeben werden. In der vorliegenden Arbeit wird ein multidisziplinärer Behandlungsansatz zur Trachealkanülenentwöhung und Dekanülierung vorgestellt, der auf der Grundlage der relevanten Forschungsliteratur und klinischen Beobachtungen entwickelt wurde. Des Weiteren wird erstmals eine systematische Evaluation eines multidisziplinären Trachealkanülenmangements vorgenommen und es werden explorative Daten zum Rehabilitationsverlauf dargestellt. In einem retrospektiven Vergleich wurden hierzu die Dekanülierungs- und Komplikationsraten sowie die Dauer der Trachealkanülenentwöhnung zweier Patientengruppen gegenübergestellt, die vor bzw. nach Einführung des beschriebenen multidisziplinären Trachealkanülenmanagements im REHAB Basel, Schweiz, behandelt wurden. Der rehabilitative Verlauf der multidisziplinär behandelten Gruppe wurde mittels der Messinstrumente FIM (Functional Independence Measure) und EFA (Early Functional Abilities) untersucht. Der Vergleich der Dekanülierungs- und Komplikationsraten ergab eine vergleichbare Effektivität der beiden Behandlungsansätze. Darüber hinaus zeigte sich eine signifikante Verkürzung der Kanülenentwöhnungsphase bei Anwendung des multidisziplinären Vorgehens, so dass dieses als effizenter zu beurteilen ist. Die Verlaufsanalyse der multidisziplinär behandelten Patienten ergab erst nach der Dekanülierung einen signifikanten Zuwachs der funktionellen Selbständigkeit in Alltagsaktivitäten. Bei der Mehrzahl der Patienten konnte ein vollständiger oraler Kostaufbau nach der Dekanülierung erreicht werden.
In neurological rehabilitation there is a growing need for information about treatment of tracheotomized dysphagic individuals and treatment methods have to be evaluated objectively. This dissertation presents a multidisciplinary approach for the treatment of tracheotomized dysphagic patients that was developed based on research findings and clinical experiences. Furthermore it presents a first approach to a systematic evaluation of a multidisciplinary treatment protocol and explorative data about the rehabilitative progress in this patient group. In a retrospective analysis mean cannulation times and the success rate of decannulation from patients were compared before and after introduction of the multidisciplinary procedure in a rehabilitation centre, REHAB Basel, Switzerland. Furthermore, the rehabilitation progress was analyzed by means of the assessment tools ‘Functional Independence Measure (FIM)’ and ‘Early Functional Abilities (EFA)’. Decannulation rates and success of decannulation were comparable in both groups of patients. With regard to mean cannulation times, however, a significant reduction was found in the group who underwent multidisciplinary treatment. This indicates a higher efficiency of the multidisciplinary approach, whereas, with regard to effectiveness, the two approaches seem to be comparable. After decannulation the patients of the multidisciplinary group showed clear functional improvements in performing activities of daily living. Most of these patients were able to return to full oral nutrition after decannulation. The multidisciplinary approach was found to be more efficient than the former intradisciplinary protocol as it led to a safe but faster decannulation of tracheotomized dysphagic patients. The explorative data concerning rehabilitation progress in these patients supports the importance of the development of evidence-based treatment protocols that lead to a fast and safe decannulation. This can be considered the basis for further significant improvement of the functional independence of the tracheotomized dysphagic patient.

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Isberg, Johanna, and Caisa Sindt. "Att kommunicera utan ord : Hur en god kommunikation kan skapas mellan patienten med trakeostomi och sjuksköterskan - En litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-319178.

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Bakgrund: Trakeostomi är ett kirurgiskt ingrepp där en öppning skapas i patientens luftstrupe vilket ofta medför att patienten förlorar sin förmåga till verbal kommunikation. För att skapa en väl fungerande kommunikation mellan patient och sjuksköterska behöver alternativa kommunikationsmetoder användas. Syfte: Syftet var att undersöka patienters upplevelse av kommunikation vid trakeostomi samt att undersöka vilka metoder som kan användas för att etablera en välfungerande kommunikation mellan patient med trakeostomi och sjuksköterska när tal inte är en möjlig kommunikationsmetod. Metod: Litteraturstudie av 14 vetenskapliga artiklar varav sju kvalitativa studier och en kombinerad kvalitativ och kvantitativ studie av patientens upplevelse av att kommunicera vid trakeostomi och sju kvantitativa studier av olika kommunikationsmetoder. Resultat: Att kommunicera med trakeostomi upplevs av patienter som frustrerande och fysiskt påfrestande. Att inte kunna förmedla sina känslor och behov leder till att patienter upplever sociala svårigheter och känner rädsla, oro och isolering från omvärlden vilket har en stor påverkan på patientens välmående. Metoder för icke verbal kommunikation som studerades var datoriserad tolkning av läpprörelser samt olika former av kommunikationstavlor som styrdes antingen genom ögonrörelser eller via en pekskärm. Samtliga metoder som studerades visade på möjligheter till en ökad förmåga att uttrycka sig och kommunicera sina behov för patienten Slutsats: Patienter med trakeostomi som inte kan kommunicera verbalt befinner sig i en utsatt situation där sjuksköterskan spelar en betydelsefull roll för patientens välmående genom att uppmärksamma patientens åsikter och behov. Det är en nödvändighet att etablera en välfungerande kommunikation genom användning av icke-verbala kommunikationsmetoder för att kunna ge patienten en vård av god kvalitet. För att kommunikationen ska bli välfungerande krävs att kommunikationsmetoderna anpassas utefter varje enskild patients behov och fysiska förmåga vilket i sin tur kräver att sjuksköterskan har kunskap om olika icke-verbala kommunikationsmetoder och är medveten om betydelsen av en välfungerande kommunikation.
Background: Tracheostomy is a surgical procedure where an opening is made in the trachea. As a result, the patient often loses his or her ability to communicate verbally. To establish a well-functioning communication between the patient and the nurse there is a need for using non-verbal methods for communication. Aim: The aim of this study was to examine patient experiences of communicating with tracheostomy and also to examine available methods for non-verbal communication between patients with tracheostomy and nurses. Study design: A review based on 14 studies was conducted. Seven were qualitative studies and one combined qualitative and quantitative describing patient experiences of communicating with tracheostomy. Seven studies had a quantitative design exploring nonverbal communication methods. Results: Patients experienced frustration, physical exhaustion and mental stress while communicating with tracheostomy. Not being able to communicate feelings and needs leads to feelings of fear, anxiety and isolation, which has a great impact on the patient's well-being. Methods for non-verbal communication which were examined was computerized reading of lip movements and different types of communication boards managed by eye tracking or with touch screen. All of the methods appeared to give the patient´s an increased possibility to express themselves and communicate their needs. Conclusion: Patients with tracheostomy are put in an exposed situation when they aren´t able to communicate verbally. The nurse has a great impact on the patient´s well-being by paying attention to his or her needs. Establishing a well-functioning communication by using nonverbal communication methods is essential to provide the patient with a good quality care. The methods for communication has to be individually adjusted to each patient’s needs and physical condition. This requires knowledge by the nurse about different non-verbal methods for communication and the importance of a well-functioning communication.

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Andrews, Jinsy A., Lisa Meng, Sarah F. Kulke, Stacy A. Rudnicki, Andrew A. Wolff, Michael E. Bozik, Fady I. Malik, and Jeremy M. Shefner. "Association Between Decline in Slow Vital Capacity and Respiratory Insufficiency, Use of Assisted Ventilation, Tracheostomy, or Death in Patients With Amyotrophic Lateral Sclerosis." AMER MEDICAL ASSOC, 2018. http://hdl.handle.net/10150/626557.

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IMPORTANCE The prognostic value of slow vital capacity (SVC) in relation to respiratory function decline and disease progression in patients with amyotrophic lateral sclerosis (ALS) is not well understood. OBJECTIVE To investigate the rate of decline in percentage predicted SVC and its association with respiratory-related clinical events and mortality in patients with ALS. DESIGN, SETTING, AND PARTICIPANTS This retrospective study included 893 placebo-treated patients from 2 large clinical trials (EMPOWER and BENEFIT-ALS, conducted from March 28, 2011, to November 1, 2012, and from October 23, 2012, to March 21, 2014, respectively) and an ALS trial database (PRO-ACT, containing studies completed between 1990 and 2010) to investigate the rate of decline in SVC. Data from the EMPOWER trial (which enrolled adults with possible, probable, or definite ALS; symptom onset within 24 months before screening; and upright SVC at least 65% of predicted value for age, height, and sex) were used to assess the relationship of SVC to respiratory-related clinical events; 456 patients randomized to placebo were used in this analysis. The 2 clinical trials included patients from North America, Australia, and Europe. MAIN OUTCOMES AND MEASURES Clinical events included the earlier of time to death or time to decline in the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) respiratory subdomain, time to onset of respiratory insufficiency, time to tracheostomy, and all-cause mortality. RESULTS Among 893 placebo-treated patients with ALS, the mean (SD) patient age was 56.7 (11.2) years, and the mean (SD) SVC was 90.5%(17.1%) at baseline; 65.5%(585 of 893) were male, and 20.5%(183 of 893) had bulbar-onset ALS. In EMPOWER, average decline of SVC from baseline through 1.5-year follow-up was - 2.7 percentage points per month. Steeper declines were found in patients older than 65 years (-3.6 percentage points per month [P=.005 vs < 50 years and P=.007 vs 50-65 years) and in patients with an ALSFRS-R total score of 39 or less at baseline (-3.1 percentage points per month [P<.001 vs >39]). When the rate of decline of SVC was slower by 1.5 percentage points per month in the first 6 months, risk reductions for events after 6 months were 19% for decline in the ALSFRS-R respiratory subdomain or death after 6 months, 22% for first onset of respiratory insufficiency or death after 6 months, 23% for first occurrence of tracheostomy or death after 6 months, and 23% for death at any time after 6 months (P<.001 for all). CONCLUSIONS AND RELEVANCE The rate of decline in SVC is associated with meaningful clinical events in ALS, including respiratory failure, tracheostomy, or death, suggesting that it is an important indicator of clinical progression.

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Zeit, Katrina Lynn. "An Assessment of Speech and Language Development in Medically Fragile Hospitalized Infants." University of Cincinnati / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=ucin990803764.

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O'Connor, Lauren. "The Safety and Efficacy of One-Way Speaking Valves." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/397598.

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Patients with tracheostomies consume a lot of healthcare resources. These patients are amongst the most critically ill, they have longer lengths of stay, higher rates of morbidity and mortality, and for those that do survive, they can take up more Intensive Care Unit bed days than patients without tracheostomies. Tracheostomies also affect a number of physiological functions, including swallowing, olfaction, and secretion management. But probably what is most significant to patients, is that the presence of a tracheostomy inhibits speech, as air no longer passes through the larynx and across the vocal cords. For decades patients with tracheostomies were unable to communicate, resulting in frustration, anxiety, and reduced quality of life. That was until the Passy-Muir Valve was created in 1985, allowing patients with tracheostomies to speak. The Passy-Muir Valve is a simple one-way valve that redirects airflow past the vocal cords, to enable speech when the tracheostomy cuff is deflated. Due to this simple unique design, it has been proposed that there may be a number of other benefits to these valves, ranging from reducing aspiration, to improving quality of life. With any novel therapy that is introduced to patients, there needs to be adequate evidence to support the use, as well as identifying risks which may put patients at harm. The evidence around the use of Passy-Muir Valve for benefits other than speech, has not yet been evaluated. The aims of this thesis are to review the literature for use of one-way speaking valves, and to evaluate the evidence for the use across all physiological domains. A systematic review was completed, evaluating the evidence for a range of physiological outcomes, including vital signs, aspiration, olfaction, ventilation, tracheostomy weaning, length of stay and quality of life. A meta-analysis random-effect model (I2 =71.76, p = 0.006) found reduced instances of aspiration with the use of a one-way speaking valve, compared to without. There were also statistically significant improvements across other physiological domains, including olfaction, secretion management, and ventilation. For the remaining outcomes, the use of a one-way speaking valve demonstrated improvements that were not statistically significant, and no study demonstrated negative outcomes. Unfortunately, safety and adverse events were not well defined in any of the studies. Subsequently, an observational study was completed to evaluate the effect on cardiorespiratory parameters, including heart rate, respiratory rate, blood pressure and saturations of oxygen, in terms of safety and physiological efficacy, with prolonged use of one-way speaking valve. The results demonstrated that once patients achieve a threshold of 2-hours with no adverse events, there does not appear to be any limitations to extended use. The prolonged use of one-way speaking valves was safe in the ICU environment for periods up to 17 hours, whilst patients continued to participate in their normal ICU cares and therapies, including showering, eating and drink, mobilising, and participating therapy, all whilst having the ability to communicate as desired. In contrast to previous studies, there were no statically significant clinical improvements with the use of a one-way speaking valve, however only physiological efficacy was studied, and no assumption on psychological efficacy could be made. As clinical skills and knowledge have improved through research, so has the model of care of ICU. No longer are patients heavily sedated for prolonged periods of time, and ICU survivorship is no longer an optimal outcome. The short and long-term quality of life of ICU patients has been under surveillance in recent years, with a new focus on reducing long-term consequences of ICU admission. Although the results from both the systematic review and observational study demonstrated no adverse clinical events, and potential improvements across physiological domains, psychological efficacy has not yet been thoroughly explored. These results indicate there is a potential for further research, particularly into psychological, and patient and family centered outcomes. Exploring the benefits of earlier, and longer, communication for patients with tracheostomies may help to improve outcomes such as Post Intensive Care Syndrome and ICU delirium.
Thesis (Masters)
Master of Philosophy (MPhil)
School Allied Health Sciences
Griffith Health
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Lemoignan, Josée. "Decision-making for assisted ventilation in amyotrophic lateral sclerosis." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101862.

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Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that leads to respiratory compromise and eventually death within two to five years. Even though people with ALS must make many treatment decisions, none has such a significant impact on quality of life and survival as the one pertaining to assisted ventilation. A qualitative research study was undertaken to elicit factors that are pertinent to this decision-making process. Ten individual, semi-structured interviews were conducted with individuals with ALS. Six main themes emerged from the interviews. These are: meaning of the intervention, the importance of context, values, and fears in decision-making, the need for information, and adaptation/acceptance of the intervention. Based on these findings, it is argued that a pluralistic conception of autonomy as well as a shared decision-making model is better suited to give high priority to patient autonomy in this context. Some recommendations to improve clinical practice are proposed.

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Gomes, Thalita Augusta Borges Fernandes. "QUALIDADE DE VIDA DO LARINGECTOMIZADO TRAQUEOSTOMIZADO." Pontifícia Universidade Católica de Goiás, 2010. http://localhost:8080/tede/handle/tede/3132.

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Made available in DSpace on 2016-08-10T10:55:59Z (GMT). No. of bitstreams: 1 THALITA AUGUSTA BORGES FERNANDES GOMES.pdf: 2983367 bytes, checksum: 5af6cf1f2345e46cdbde3289ac885e69 (MD5) Previous issue date: 2010-03-19
Laryngeal cancer is responsible for approximately 75,300 deaths per year worldwide, an incidence of approximately 136,000 new cases per year, occurring predominantly in males. Several risk factors have been associated with the development of cancer of the larynx, especially tobacco, alcohol, radiation and occupational exposure. Surgical procedures for removal of the laryngeal tumor, represented by either or Partial laryngectomy generate temporary or permanent mutilation for the patient according to the tracheostomy associated with determining a complete change in the biological functions of the larynx, altering their quality of life. This study was a quantitative research to verify the quality of life of laryngectomized patients with tracheostomy, using as instrument the UWQOL, version 4, was obtained as a result of the speech as the greatest impact among patients below 60 years, including the distinction between men and women, being considered statistically smaller in women. For patients over 60 years, the greatest impact was in swallowing and overall quality of life was considered good.
O câncer laríngeo é responsável por aproximadamente 75.300 mortes por ano em todo mundo, numa incidência de aproximadamente 136.000 novos casos/ano, ocorrendo predominantemente no sexo masculino. Vários fatores de risco têm sido associados ao desenvolvimento de câncer de laringe, especialmente, tabaco, álcool, radiação e exposição ocupacional. Os procedimentos cirúrgicos realizados para a remoção do tumor laríngeo, representados tanto por Laringectomias Totais ou Parciais, geram mutilações definitivas ou temporárias para o paciente em função da traqueostomia associada, determinando uma modificação completa nas funções biológicas da laringe, alterando sua qualidade de vida. O presente estudo realizou uma pesquisa quantitativa de verificação da qualidade de vida do laringectomizado traqueostomizado, utilizando-se como instrumento o UW-QOL versão 4, obtendo-se como resultado a fala como o maior impacto entre os pacientes abaixo dos 60 anos, inclusive na distinção entre homens e mulheres, sendo considerado estatisticamente menor nas mulheres. Para os pacientes acima dos 60 anos, o maior impacto foi no domínio deglutição e a qualidade de vida global foi considerada como boa.

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Berisha, Donika, and Serbest Ucmaz. "Från sjukhusvård till vård i hemmet för barn med nyanlagd trakeostomi : Sjuksköterskors erfarenheter." Thesis, Hälsohögskolan, Jönköping University, HHJ, Avd. för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-48858.

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För att transition från sjukhusvård till vård i hemmet hos ett barn med nyanlagd trakeostomi ska bli effektiv och smidigast möjlig bör vården av dessa barn och familjer individanpassas. Varje familj bör i ett tidigt skede erbjudas ”förväntningssamtal” där parterna delger sina förväntningar på varandra. Familjerna bör även stöttas med andra samtal för att mötas i deras krisarbete samt erbjudas dialog och uppföljning under hela sjukhusvistelsen. Familjerna bör ges möjlighet att i ett tidigt skede ta del av den tänkta behandlingsplanen för barnet och därmed skapa en delaktighet och engagemang hos föräldrarna för att sjukhusvistelsen ska bli kortast möjlig. Detta i sin tur kan bidra till att skapa en naturlig förståelse för den vård i hemmet som i ett senare skede ska bedrivas av föräldrar och assistenter, därmed får föräldrarna dessutom möjlighet att i ett tidigt skede läras upp. Vidare bör kommunerna, som ansvarar för att tillhandahålla familjerna och barnet assistans i hemmet, i ett tidigt skede involvera familjen och sjuksköterskorna vid urval av tilltänkta assistenter till uppdraget. Genom att involvera föräldrarna i ett tidigt skede kan föräldrarna komma att känna ett större engagemang. Detta kan även bidra till att föräldrarna kan få ett större förtroende för assistenterna vilket kan ge goda förutsättningar för att korta ned upplärningsfasen och därmed sjukhusvistelsen. Relevant kompetens och erfarenhet hos sjuksköterskor är en förutsättning för att undvika utdragen sjukhusvistelse samt att kunna betrygga familjer och assistenter som barnets primära omsorgspersoner för att de i ett senare led ska kunna möta situationer och ta livsavgörande beslut i hemmet. Att vårda barn med nyanlagd trakeostomi inför transition till hemmet innebär ett stort ansvar. Riktig och likvärdig information ska ges vid upplärning till föräldrar och assistenter samtidigt som det ska möjliggöras för en bemästring inför ägarskap till att vara föräldrar och assistenter till ett barn med speciella behov.

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Moore, Kristi A. "Interprofessional Patient Simulation Training Compared to Online Training for learning to use In-Line Speaking Valves." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etd/3021.

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Restoring speech in persons who are tracheostomy and ventilator dependent, through the use of a Passy-Muir Speaking Valve (PMSV), requires specific training. Methods of training interprofessional team members to assess in-line PMSVs are unclear. This study used a pretest/ post-test design to compare effects of online training and online training plus simulation training on knowledge acquisition, skills performance, and comfort levels when working with persons who are tracheostomy and ventilator dependent. Twenty-six students studying either respiratory therapy (N=13) or speech-language pathology (N=13) were assigned to the control group or experimental group. Results revealed that online training proved beneficial for increasing tracheostomy and ventilator knowledge. Participants who underwent simulation training reported greater levels of comfort and demonstrated more efficient skills performance during simulation post-testing. Simulation training is efficacious to train interprofessional teams how to properly assess this population for use of in-line PMSVs.

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Norman, Vivienne Rose. "The need for speech and language therapy intervention for infants and toddlers with tracheostomies a retrospective study /." Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-09102007-113757.

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35

Ramos, Michele de Cassia Santos. "Estudo comparativo de pacientes neurocirúrgicos submetidos à traqueostomia precoce e tardia durante o período na unidade de terapia intensiva em um hospital terciário." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-12052015-091053/.

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Aproximadamente 24% dos pacientes graves na unidade de terapia intensiva (UTI) são submetidos à traqueostomia (TQT), e a diminuição do trabalho respiratório, o desmame ventilatório precoce e facilidade na higiene brônquica são os benefícios mais comuns neste procedimento, porém são descritos em pacientes heterogêneos. O período da TQT precoce permanece controverso, mesmo que este procedimento seja descrito há séculos, e entre os pacientes que frequentemente requerem ventilação mecânica prolongada (VMP) estão os neurocirúrgicos e são susceptíveis ao desenvolvimento de complicações sistêmicas e pulmonares. Além disso, há poucos estudos sobre os benefícios da TQT precoce em pacientes neurocirúrgicos com características homogêneas e esses são retrospectivos. Não há relatos sobre o custo indireto e o desfecho hospitalar desse pacientes, portanto, o objetivo desse estudo foi analisar o tempo de ventilação mecânica invasiva (VMI), tempo de estadia na UTI em dias, tempo de estadia hospitalar em dias, custo indireto, ocorrência de complicações e o desfecho hospitalar em pacientes neurocirúrgicos submetidos à TQT precoce e tardia. Estudo prospectivo observacional, realizado no Instituto Central do hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre o período de Dezembro de 2009 a Junho de 2011. Foram incluídos os pacientes neurocirúrgicos admitidos na UTI, e submetidos à TQT após a intubação traqueal. Eles foram divididos em Grupo TQT Precoce (GTP): <= 7 dias de VMI e Grupo TQT Tardio (GTT): > 7 dias. Nível significativo adotado foi p<= 0,05. Foram incluídos 72 pacientes, 21 pacientes no GTP e 51 no GTT. A idade (GTP= 48, GTT= 51, p=0,101), gênero masculino (GTP= 16, GTT= 35, p=0,521), Apache II (GTP= 15, GTT= 15, p=0,700), Escala de Coma de Glasgow (GTP= 7, GTT= 7, p= 0,716) não apresentaram diferença entre os grupos. O GTP apresentou menor tempo de VMI (p < 0,001), tempo de estadia na UTI (p=0,001), tempo estadia no hospital (p=0,001) e custo indireto (p =< 0,001). A infecção nosocomial (IN) foi a complicação identificada, a IN sistêmica (p=0,088), IN pulmonar (pneumonia associada à ventilação mecânica (p=0,314), sobrevida (p=0,244) e o desfecho hospitalar mais comum (transferência para hospital de longa permanência) (p=0,320), não apresentaram diferença significativa entre os grupos. Em pacientes neurocirúrgicos, a TQT precoce reduziu o tempo de VMI, tempo de estadia na UTI, tempo de hospitalização e custo indireto. Porém não houve diferença na ocorrência de complicações e no desfecho hospitalar entre os grupos
Nearly 24% of the critically ill patients in intensive care unit (ICU) are submitted to tracheostomy (TQT), and the decrease the work of breathing, early weaning and pulmonary toilet are the most common benefits in this procedure, however these benefits are described in heterogeneous patients. The period of early TQT remains controversial, even if this procedure is described for centuries, and between the patients often require prolonged mechanical ventilation (PMV) are the neurosurgical and are susceptible to the development of systemic and pulmonary complications. In addition, there are few studies about the benefits of early TQT in neurosurgical patients with homogeneous characteristics and these are retrospective. There are no reports on the overhead and the hospital outcome of patients, therefore, the aim of this study was to analyze the duration of mechanical ventilation (MV), ICU length of stay (LOS) days, hospital LOS days, indirects costs, occurrence of the complications and patients discharge in neurosurgical submitted to early and late tracheostomy. Prospective, observational study, at the Central Institute of the Clinics Hospital, Medical School, University of São Paulo, from December 2009 until June 2011. Neurosurgical patients admitted at the ICU were included, and submitted to TQT after tracheal intubation were included. They were categorized in Early Tracheostomy Group (ETG) <= 7 days MV and Late Tracheostomy Group (LTG) > 7 days. Statistical analysis significance p < 0.05. 72 patients were included, 21 patients in ETG and 51 in LTG. Age (ETG= 48, LTG= 51, p=0.101), male (ETG 48, GTT= 51, p=0.521), Apache II (ETG= 15, LTG= 15, p=0.700), Glasgow coma scale (ETG= 7, LTG= 7, p= 0.716) no significant different between the groups. The ETG had shorter length of VM (p < 0.001), ICU LOS (p=0.001), hospital LOS (p=0.001) and indirects costs (p < 0.001). Nosocomial Infection (NI) was identificated complication, systemic NI (p=0.088), pulmonary NI (ventilator associated pneumonia- PAV) (p= 0.314), survival (p=0.244) and the most common hospital outcome (transfer to long-term care hospital) (p= 0.320), there were no significant difference between the groups. In neurosurgical patients, the early tracheostomy reduced length of MV, ICU LOS, hospital LOS and the indirects costs. However, there were no difference in the occurrence of complications and patient discharge between the groups

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Santos, Tatiana Sousa. "Brachycephalic obstructive airway syndrome : a review with six clinical cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/11846.

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Dissertação de Mestrado Integrado em Medicina Veterinária
Brachycephalic breeds are well known to have respiratory issues due to anatomical changes in their skull such as stenotic nares, elongated soft palate and abnormal nasopharyngeal turbinates. These changes increase respiratory resistance, leading to a higher negative pressure – inspiratory pressure. With time this increased negative pressure will lead to the development of secondary changes, such as laryngeal collapse, palate and laryngeal oedema, swelling, saccule and tonsil eversion. All of this combined obstructs even further the upper respiratory tract. Animals usually presents exercise intolerance, stertous breathing, hyperthermia, snoring, and in some severe cases cyanosis and collapse may occur. This prospective study aims to characterize a small sample of six brachycephalic dogs, relating their breed, age, gender, clinical presentation, primary changes and secondary changes detected. According to their clinical presentation the patients underwent individual surgical correction. The pool sample consisted of 50% Pugs, 33% English bulldogs and 17% French bulldogs, with ages ranging from 5 months to 5 years old. The most frequent clinical signs were stertous breathing, 100%, exercise intolerance, 100%, regurgitation, 66.67%, retching, 66.67% and coughing, 50%. After the brachycephalic obstructive airway syndrome (BOAS) investigation procedures, which included direct observation of the soft palate and larynx, radiographs, CT scan and bronchoscopy with BALs, the most common primary changes found were stenotic nares, 100%, and elongated/thick soft palate, 83.34%. The secondary changes are chronic changes due the prolonged increased negative pressure. These were found in older patients, being the most frequent laryngeal saccules eversion, 40% and laryngeal collapse, 40%. According to their clinical presentation and abnormalities found the patients underwent individual surgical correction. There are surgical techniques available to correct some components and secondary changes of this brachycephalic syndrome. The two major procedures are rhinoplasty, performed in all patients of this study and palatoplasty performed in 60% of patients. Due the severe effects on quality of live one patient of this study was euthanized. All five cases that underwent surgical treatment had a good recovery, with no complications after the procedures. One week after the procedure the owners were contacted and reported improvements in the dog exercise time and breathing.
RESUMO - Síndrome respiratória obstrutiva dos braquicefálicos: Uma revisão com seis casos clínicos - Raças de cães braquicefálicos são conhecidas por desenvolver problemas respiratórios relacionados com alterações anatómicas do seu crânio com estenose das narinas, prolongamento do palato mole e turbinados anormais nasofaríngeos. Estas alterações aumentam a resistência respiratória, culminando numa pressão negativa elevada – pressão inspiratória. Com tempo este aumento da pressão negativa leva ao desenvolvimento de alterações secundárias, como colapso da laringe, edema do palato e laringe, turgescência, eversão dos sáculos laríngeos e tonsilas. Todas estas alterações obstroem ainda mais as vias respiratórias superiores. Os animais normalmente apresentam intolerância ao exercício, respiração ruidosa, hipertermia, roncos, e em casos mais graves cianose e colapso podem ocorrer. Este estudo prospetivo pretende de uma caracterizar uma pequena amostra de seis cães braquicefálicos, relativamente à raça, idade, género, sintomas/sinais clínicos, exame imagiológicos, decisão terapêutica e prognóstico, e a sua comparação com a bibliografia, alterações primárias e secundárias. A amostra consiste em 50% Pugs, 33% Bulldog inglês e 17% Bulldog francês, com idades variando entre 5 meses a 5 anos. Os sinais clínicos mais frequentes foram respiração ruidosa, 100%, intolerância ao exercício, 100%, regurgitação, 66.67, esforço para vomitar, 66.67% e tosse, 50%. Após aos procedimentos de investigação da síndrome, que incluíam observação direta do palato mole e laringe, radiografias, tomografia axial computadorizada (TAC) e broncoscopia com lavagem broncoalveolar (LBA), as alterações primárias mais frequentemente encontradas foram estenose das narinas, 100%, e prolongamento/espessura do palato mole, 83.34%. As alterações secundárias tem caracter crónico devido ao aumento prolongado da pressão negativa. Estas são encontradas em pacientes mais velhos, sendo as mais frequentes eversão dos sáculos laríngeos, 40% e colapso da laringe, 40%. De acordo com a sua apresentação clinica e alterações encontradas os pacientes foram submetidos a correção cirúrgica personalizada. Existem técnicas cirúrgicas para corrigir alguns componentes e alterações secundárias desta síndrome dos braquicefálicos. Os dois procedimentos principais são rinoplastia, realizada em todos os pacientes deste estudo, e palatoplastia realizada em 60% dos pacientes.

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Gallice, Thomas. "Optimisation de la rééducation de la déglutition et du sevrage de la trachéotomie chez le patient cérébro-lésé." Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0372.

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Les patients victimes de lésions cérébrales graves et hospitalisés en réanimation bénéficient fréquemment de la pose d’une trachéotomie. En phase aigüe, celle-ci présente de nombreux avantages et facilite notamment le sevrage de la ventilation mécanique, ainsi que la sortie des patients de la réanimation. Cependant, la présence d’une trachéotomie pose deux problèmes : elle est susceptible d’entrainer ou de majorer les troubles de la déglutition et elle peut être un frein à l’orientation des patients cérébro-lésés vers des structures de soins secondaires. Le sevrage de la trachéotomie apparait donc comme une étape indispensable à la rééducation du patient. Différents protocoles de sevrage existent mais ils s’appuient généralement sur l’expertise de certains professionnels ou sur une évaluation instrumentale. De plus, certaines pratiques du sevrage, comme l’utilisation du clapet phonatoire ne font pas consensus. Le sevrage de trachéotomie apparait ainsi comme complexe, dangereux et nécessitant des compétences et des ressources importantes. Nous avons créé un protocole de sevrage pluridisciplinaire en 5 étapes, basé uniquement sur des critères d’évaluations cliniques adaptés à chaque patient. Celui-ci peut être utilisé en autonomie, hors d’un service de réanimation et sans évaluation instrumentale. Son fonctionnement est celui d’un algorithme décisionnel. Nous avons testé ce protocole dans une étude de cohorte prospective incluant 30 patients cérébro-lésés et trachéotomisés. Nous avons obtenu un taux de décanulation de 90%, un taux de réussite de 100% et une durée moyenne de sevrage de 7.6 [ET : 4-6] jours. Conjointement, nous avons évalué l’effet du clapet phonatoire sur le débit aérien dans les voies aériennes supérieures, lors d’un sevrage de la trachéotomie. L’analyse des enregistrements polygraphiques, réalisés sur 15 patients cérébro-lésés trachéotomisés, montre que l’utilisation d’un clapet phonatoire, ballonnet dégonflé, est nécessaire à l’obtention d’un débit expiratoire dans les voies aériennes supérieures. Ce débit expiratoire est quant à lui indispensable à la réhabilitation de la déglutition. Le dégonflage du ballonnet seul semble être insuffisant pour rediriger l’air expiratoire vers les voies aériennes supérieures. En l’absence de clapet phonatoire, la trachéotomie apparait comme étant la voie la plus courte et offrant le moins de résistances à l’expiration. Dans l’objectif de déterminer les facteurs prédictifs d’une décanulation sans échec dans la population des patients cérébro- lésés, une revue systématique de la littérature a été conduite en parallèle de nos précédents travaux. Après avoir interrogé les bases de données suivantes : MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, PEDro, OPENGREY, OPENSIGLE, Science Direct, CLINICAL TRIALS et Central, nous avons identifié 1433 articles, parmi lesquels 26 étaient éligibles à l’inclusion dans cette revue. Les facteurs prédictifs principaux étaient : un bon état neurologique, un traumatisme crânien (plutôt qu’un AVC ou une anoxie cérébrale), l’âge, une déglutition et une toux efficaces et l’absence d’infection pulmonaire. Les facteurs prédictifs secondaires étaient : une trachéotomie précoce, des lésions supra-tentorielles, l’absence de faiblesse musculaire acquise en réanimation et l’absence de lésion trachéale. L’identification de ces facteurs prédictifs permettra de cibler, parmi les patients cérébro-lésés trachéotomisés, ceux nécessitant une évaluation, une surveillance ou une prise en charge particulière
Patients suffering from serious brain injuries and hospitalized in intensive care units frequently benefit from the insertion of a tracheostomy. In the acute phase, this has numerous advantages and notably facilitates weaning from mechanical ventilation, as well as the discharge of patients from intensive care unit. However, the presence of a tracheostomy poses two problems: it is likely to cause or increase swallowing disorders and it can be an obstacle to the discharge of brain-injured patients to secondary care structures. Weaning from tracheostomy therefore appears to be an essential step in the patient's rehabilitation. Different weaning protocols exist but they generally rely on the expertise of certain professionals or on an instrumental evaluation. Moreover, certain weaning practices, such as the use of the speaking valve, do not achieve consensus. Weaning from tracheostomy thus appears to be complex, dangerous and requiring significant skills and resources. We have created a multidisciplinary weaning protocol in 5 steps, based solely on clinical evaluation criteria adapted to each patient. This can be used independently, outside of an intensive care unit and without instrumental evaluation. This protocol works as a decision-making algorithm. We tested this protocol in a prospective cohort study including 30 brain-injured and tracheostomized patients. We obtained a decannulation rate of 90%, a success rate of 100% and an average weaning duration of 7.6 [SD: 4-6] days. Jointly, we evaluated the effect of the speaking valve on air flow in the upper airways during tracheostomy weaning. The analysis of polygraphic recordings, made on 15 brain-injured tracheostomized patients, shows that the use of a speaking valve with a deflated cuff is necessary to recreate an expiratory flow in the upper airways. This expiratory flow is essential for the rehabilitation of swallowing. Cuff deflation alone appears to be insufficient to redirect expiratory air to the upper airway. In the absence of a speaking valve, tracheostomy appears to be the shortest and easiest route for the expiratory flow. With the aim of determining the predictive factors of successful decannulation in the population of brain-injured patients, a systematic review of the literature was conducted in parallel with our previous work. After querying the following databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, PEDro, OPENGREY, OPENSIGLE, Science Direct, CLINICAL TRIALS and Central, we identified 1433 articles, of which 26 were eligible for inclusion in this review. The main predictive factors were: a high neurological level, traumatic lesions (rather than stroke or cerebral anoxia), age, effective swallowing and coughing and the absence of pulmonary infections. Secondary predictive factors were: early tracheostomy, supratentorial lesions, absence of critical illness polyneuropathy/myopathy and absence of tracheal lesions. The identification of these predictive factors can be useful to target among brain-injured tracheostomized patients, those requiring evaluation, monitoring or specific care

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Siqueira, Nuno Maria Furtado de Antas Almadanim de. "Estudo retrospetivo sobre traqueostomia permanente como tratamento cirúrgico em cães com síndrome braquicefálica obstrutiva." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/12254.

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Dissertação de Mestrado Integrado em Medicina Veterinária
Com o crescente interesse nas raça com um conformação braquicéfala extrema (e.g. Buldogues francês), o numero de casos de síndrome braquicefálica obstrutiva (SBO) tende a aumentar. Este estudo retrospetivo descreve os resultados obtidos em cães traqueostomizados de forma permanente devido a colapso da laringe, secundária a SBO. Foram utilizados dados (n=6) do Hospital Veterinário da Universidade de Ghent, durante um período de 10 anos, (2005-2015). Toda a história clinica dos pacientes foi acompanhada incluindo: idade ao diagnóstico de SBO, alterações primárias e secundárias, idade à data da traqueostomia permanente, complicações, estado de saúde do paciente à data do estudo, tempo de sobrevivência, percepção do dono quando à qualidade de vida do animal antes e após traqueostomia permanente. Ocorreram complicações em todos os casos, dos quais 66,67% tiveram complicações maiores, em todos estes houve necessidade de pelo menos uma revisão cirúrgica, tendo sido necessárias até quatro novas intervenções num dos casos. Um dos pacientes morreu de forma aguda com suspeita de asfixia por obstrução do traqueostoma. O tempo médio de sobrevivência após traqueostomia permanente foi de 662 dias. Segundo os donos os animais tiveram um aumento médio de qualidade de vida de 1,83 valores numa escala de 1 a 5. A traqueostomia permanente é um procedimento de recurso indicado em pacientes com colapso laríngeo de grau III, no entanto são espectáveis complicações, necessidade de revisão cirúrgica e em alguns casos morte aguda por asfixia.
ABSTRACT - Due to the increasing popularity of the brachycephalic breads, particularly the ones with more extreme conformation (e.g. French Bulldog), brachycephalic obstructive syndrome (BOS) cases tend to become more common. This retrospective study, reports long-term outcome of dogs that underwent permanent tracheostomy secondary to laryngeal collapse due to BOS. Data from 6 cases was collected from medical records of the University of Ghent Veterinary Hospital, over a 10-year period (2005-2015). Patients history was followed and reviewed including: Age when diagnosed with BOS, primary and secondary anatomic BOS changes, age when submitted to permanent tracheostomy, major and minor complications, animal health at the time of study, survival time, owners perception of the patients quality of life previously and after permanent tracheostomy. Complications occurred in all the patients, 66,67% of those had major complications, these underwent revision surgery at least once, however one of the patients had 4 revision interventions. One of the patients died acutely at home, which was thought to be due to asphyxiation. Mean survival time was 662 days. The owners reported an increase of 1,83, on a scale from 1 to 5, in the patient’s quality of life posterior to the permanent tracheostomy. Permanent tracheostomy is a last resource therapy indicated in animals with laryngeal collapse stage III, clinicians and owners should expect complication, revision surgeries and cases of acute death.

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Nunes, Diego Silva Leite. "Avaliação da sobrevida e fatores associados em pacientes críticos crônicos comparando duas definições em uma coorte histórica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/117013.

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Base teórica: O avanço no conhecimento e a introdução de tecnologias mais sofisticadas para o cuidado do paciente crítico trouxeram importante incremento na sobrevida deste grande grupo de pacientes. Por outro lado, existe um estrato de pacientes que sobrevivem à condição crítica aguda, porém permanecem dependentes de algum tipo de suporte de manutenção da vida por longos períodos. A doença crítica crônica (DCC) como é conhecida, apesar de descrita desde a década de 80, ainda não possui um critério de definição claro, levando a divergências nos resultados de estudos e prejudicando o avanço em pesquisas que investigam estratégias de tratamento. Objetivo: Avaliar a sobrevida e fatores associados à DCC em uma população de pacientes críticos comparando dois critérios de diagnóstico desta condição. Metodologia: Coorte histórica com avaliação de variáveis clínicas e desfechos durante a internação hospitalar em uma população de doentes críticos de uma única unidade de tratamento intensivo (UTI). Os pacientes foram alocados em três grupos, dois com critérios de DCC definidos por ≥14 ou ≥21 dias de ventilação mecânica (VM) e um terceiro grupo de pacientes críticos agudos (< 14 dias de VM). Recrutamento e alocação foram feitos através de um banco de dados institucional e dos registros hospitalares das internações ocorridas de janeiro de 2007 a dezembro de 2010. Resultados: No período analisado ocorreram 3.023 internações na UTI, 2.783 apresentavam os critérios de inclusão e compuseram a análise final. Em relação ao tempo de VM, 163 pacientes apresentaram ≥14 dias e 89 ≥21 dias. A mortalidade hospitalar e na UTI foi inferior no grupo de pacientes críticos agudos quando comparado com os dois grupos de DCC (≥14 e ≥21 dias de VM) (16.3% versus 55.8% e 58.4% p<0.001; 10.6% versus 47.3% e 53.9% p<0.001 respectivamente). Quando comparados os dois grupos de DCC (≥14 e ≥21 dias de VM), não houve diferença estatisticamente significativa para mortalidade hospitalar e na UTI (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18 respectivamente). O pequeno número de pacientes em cada grupo pode ter limitado o poder das análises. Ambos os grupos de DCC tiveram escores de gravidade mais altos, desenvolveram mais complicações na UTI, apresentaram maior tempo de internação hospitalar e mortalidade quando comparados aos críticos agudos. Conclusão: O estudo não mostrou diferença estatisticamente significativa quanto às características e desfechos clínicos entre as duas definições de DCC. Por outro lado, mostrou que os dois grupos de DCC apresentaram desfechos piores quando comparados com os pacientes críticos agudos. Estes resultados justificam o uso do critério de ≥14 dias de VM para a identificação mais precoce dos doentes críticos crônicos.
Theoretical basis: Progress in knowledge and the introduction of more advanced technologies for critical patient care brought about an important increase in the survival of this large group of patients. On the other side, there exists a subset of patients who survive their acute critical illness, but they remain dependent on some kind of life support for long periods. Despite being described since the 1980s, the chronic critical illness (CCI) has still not been clearly defined. This situation led to divergent studies’ results and jeopardized the progress in research focused on treatment strategies for CCI. Objective: To assess the survival and CCI-associated factors in a population of critically ill patients comparing two diagnostic criteria of this condition. Methodology: Historical cohort study assessing clinical variables and outcomes during hospital stay, in a population of critically ill patients of a single intensive care unit (ICU). The patients were divided into three groups, two of these with different criteria of CCI, defined by ≥14 or ≥21 days of mechanical ventilation (MV), and a third group with acutely critically ill patients (less than 14 days of MV). The recruitment and allocation were carried out through an institutional database and medical records of admissions occurred from January 1, 2007 to December 31, 2010. Results: In the study period 3,023 ICU admissions occurred, 2,783 met the inclusion criteria and made part of the final analysis. As far as MV days are concerned, 163 patients had ≥14 days and 89 ≥21 days. Hospital and ICU mortality were lower in the group of acutely critically ill patients compared with the two CCI groups (≥14 days and ≥21 MV days) (16.3% versus 55.8% and 58.4% p<0.001; 10.6% versus 47.3% and 53.9% p<0.001 respectively). The comparative analysis between the two CCI groups (≥14 days and ≥21 MV days, respectively) was not statistically significant for hospital and ICU mortality (57.2% versus 58.4% p=0.5; 39.2% versus 53.9% p=0.18, respectively). The small number of patients in the two groups may have limited the power of analyzes. Both CCI groups had higher severity scores, developed more ICU complications, showed higher hospital length of stay and mortality when compared with the acutely critically ill patients. Conclusion: This study did not show significant difference between the two CCI definitions regarding characteristics and clinical outcomes. However, it showed that both groups had worse outcomes when compared with the acutely critically ill patients. This result justifies the use of the CCI criteria of ≥14 days of MV for earlier identification of this subset of patients.

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Rwakonda, Munyaradzi Ephie. "Lived Experiences of Individuals Quality of Life on Prolonged Home Mechanical Ventilation." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4558.

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Improvements in technology have allowed people with tracheostomies to live at home on mechanical ventilation (HMV). Quality of life (QOL) for HMV users has been studied quantitatively, but few qualitative studies have been published. The purpose of this phenomenological study was to explore QOL for individuals with tracheostomies on prolonged HMV focusing on activities of daily living (ADLs) and the role of decision- making. The Roper, Logan, and Tierney activities of living theory were used to categorize activities. Ten participants, 18 years and older, with a tracheostomy and on HMV for at least 6 months were enrolled using purposive sampling. Data were collected through structured, in-depth, face-to-face interviews. Themes that emerged were (a) autonomy, (b) significance of ventilator for well-being, (c) feeling tied up, (d) creating meaning, (e) tipping point, (f) reminiscence, (g) building trust and confidence, (h) adjusting to technology, (i) family support and relationships, and (g) meaning of life. The participants were relatively healthy and their QOL was improved when they were on HMV compared to the hospital. The participants felt empowered that they had control in their daily lives at home when they had competent caregivers and family members for continuity of care. Recommendations for future research would include exploring improved methods of collaboration among health care workers and families in providing holistic care and reducing role strain and isolation in young HMV users. The study may promote positive social change through education for family, health care workers, and the public about strategies to promote independence and subsequent improvement in QOL for individuals on HMV.

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GREA, ALAIN. "De la canule de tracheostomie chez le laryngectomise." Lyon 1, 1990. http://www.theses.fr/1990LYO1M004.

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BORROMINI, CHARLES. "Infections broncho-pulmonaires staphylococciques a repetition apres tracheostomie." Toulouse 3, 1988. http://www.theses.fr/1988TOU31079.

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Kanat, Blomkvist Siham, and Sanna Söderbäck. "Patienters upplevelse i samband med tracheostomi samt dess påverkan på livskvalitén." Thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-33011.

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PETREMANN, LAURENT. "L'handicap ventilatoire de la tracheostomie : etude de 25 malades laryngectomises." Lyon 1, 1992. http://www.theses.fr/1992LYO1M044.

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Herbst, Wiebke. "Neurogene Dysphagien und ihre Therapie bei Patienten mit Trachealkanüle /." Idstein : Schulz-Kirchner, 2000. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=008736184&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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Svanström, Maria, and Ulrica Karlsson. "Sjuksköterskan som höll min hand... Intensivvårdspatienters upplevelser av att vara intuberad eller tracheostomerad - en litteraturstudie." Thesis, Karlstads universitet, Avdelningen för omvårdnad, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-14461.

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Being a patient in intensive care can be experienced terrifying. Studies have demonstrated the link between unpleasant memories of hospitalization in the ICU and the development of posttraumatic stress disorder, depression, anxiety, and perception of quality of life in its aftermath. Placed on a ventilator, the patient is exposed to multiple invasive procedures. The aim was to describe critical care patients' experience of being intubated or tracheostomated. Method: Literature review using conventional content analysis. Searches were made in the databases Cinahl and Pubmed. Results: The study revealed four main categories: Discomfort, Vulnerability and Communication difficulties that were tied together by category Relief. It turned out that the patients experienced a discomfort caused by the endotracheal tube. Suctioning of airways remembered many of the patients in both discomfort and relief. Being dependent on a ventilator and equipment in order to survive, causing a feeling of vulnerability. Many patients lost hope when they could not communicate, make themselves understood and to be involved in their care. The medical staff has a significant impact on their experiences of intensive care. To find out the reason they were intubated / tracheostomated reduced their fear. This information helped them to bond with reality. The nurse has responsibility to act with compassion and empathy, theory and knowledge to reduce anxiety and facilitate hospital stay for patients.

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Hedlund, Niclas. "Tyst kunskap och produktdatasystem vid medicinteknisk tillverkning : Pilotstudie av system för produktdatahantering och kartläggning av den tysta kunskapen vid Nationellt respirationscetrum, NRC." Thesis, Uppsala University, Department of Information Technology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-126753.

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This thesis looks at two sides of the same coin: how to support the production and future development at a specialist medical technology department at Danderyd Hospital. The two sides are; a pilot study of a product management system (PDM) and an interview based study on the characteristics of the silent knowledge of the technicians. The department (National respiratory centre, NRC) is facing retirement of several key employees.

The technical study shows that the success of an implementation is largely dependent on the users’ prior knowledge and use of a 3D Computer aided design system (CAD).The system itself is shown to fulfill the Lifecycle requirement of tracking the products (mostly tracheostomy tubes) but without a CAD centered workflow, some substantial education and preferably some new recruits, an implementation of the PDM system will fail. The author recommends development of the current “low-tech” system of MS Excel and Access rather than redistribute the dependency from technician towards a complex, commercial software and its vendor.

The analysis of the technicians’ silent knowledge with the newly developed method, epithet for silent knowledge (ETK), shows that the longer employment time:

the more differentiated technicians become in describing their work,
practical knowledge are regarded higher and
the social and collective problem solving factors of the work becomes more important.

Typically, it is shown that a new employee should preferably enjoy problem solving, being pragmatic and social as well as having some prior education or work experience in a CAD and/or a PDM system.

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Jacobs, Christopher Richard. "Paediatric tracheostomies in Johannesburg: a ten year review." Thesis, 2013. http://hdl.handle.net/10539/12641.

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Introduction A tracheostomy in the paediatric age group is a created clinical situation that demands highly specialized care. Whilst the procedure itself may be performed as a lifesaving measure, the high level of care required to maintain this artificial airway is unfortunately associated with a higher morbidity and mortality than in the adult tracheostomy patient. The successful management of these young patients with the burden of a tracheostomy airway requires the overcoming of many challenges, particularly those of a resource poor environment. No standard protocol of care for these patients exists, with care practices and care related complications varying widely between institutions and regions. Shifts in age and indication demographics have been noted internationally, with infants now comprising the largest age group, and prolonged intubation for ventilation the most common indication. Aims The aims of this study were to describe: The demographics viz. the age, indications, and outcomes for these patients - in the Johannesburg Public Hospital Sector, thus providing a basis for understanding the patient profile, and The particular clinical problems encountered in this local and regional setting. Materials and Methods A retrospective study was conducted, selecting and evaluating data over a 10 year period from 1st January 2001 to 31st December 2010. All Patients in the age group less than 18 years of age were identified. These patients had undergone the procedure of tracheostomy in any of the four Johannesburg Academic Hospitals viz. Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital, and Rahima Moosa Mother and Child Hospital. These patients were evaluated for age and for indication profiles, and for complications associated with the technical procedure and /or of the care of this artificial airway. Various factors were identified in ascertaining the effect on the final outcome. Results of Case Identification: Complete clinical records were found for 70 patients. The ages ranged from 2 weeks (neonate) to 17 years, with a mean age of 7 years. Only 18.5 % of patients were infants (under 1 year of age), with the neonatal age group accounting for just 4% (n= 3) of cases. The largest proportion was the 5.1- 10 year age group (30% of cases). INDICATIONS: 1. The most common indication group for tracheostomy were those with a potentially life threatening upper airway obstruction. These accounted for 67% (n = 47) of the cases. 2. Only 12% (n = 9) of cases were performed for prolonged intubation for positive pressure mechanical ventilation associated with respiratory disease. 3. Central nervous system disease associated with a depressed level of consciousness accounted for 14% (n = 10) of cases. 4. Five percent (n = 4) were indicated for surgical prophylaxis associated with potential upper airway compromise. Specific indications within these groups showed that the highest numbers of tracheostomies were performed for subglottic stenosis of the laryngeal airway, accounting for 28% of cases, and severe head trauma (i.e. requiring airway protection for depressed level of conciousness), accounting for 12% of cases. Glottic stenosis consequent on repeated surgeries for excision or ablation of recurrent laryngeal papillomata accounted for 7% of cases. MORBIDITIES: A total of 65 morbidities were encountered in 41 patients. The most commonly encountered complication was tracheostomy tube / cannula obstruction with blood clots and/or thickened, desiccated pulmonary secretions - with 23 episodes accounting for 35% of complications. Nosocomial Pneumonia was the second most common complication, accounting for 33% of cases (n=22). Other complications included: Operative site bleeding, Accidental early decannulation, Local wound infection, Neck and chest wall surgical emphysema, Exuberant granulation tissue formation, and Cannula breakage with aspiration. Complication rates in the neonatal and infant subgroups were significantly higher than in other age groups (p = 0.0296), with an average complication rate of 1.53 events per patient. MORTALITY: An overall mortality rate of patients with tracheostomies was found to be 27%. The mortality rate associated directly with tracheostomy care accounted for 8.5%. Of these cases, 86% were due to cannula airways obstruction (n = 5). The mean age of the patients that died from acute cannula obstruction was 2.45 years (i.e. the toddlers). IN-HOSPITAL STAY: The duration of in-hospital stay from day of procedure to release from in-hospital based care revealed a mean of 147 days (Range 5 – 1360 days). The largest percentage of patients (44%, n = 31) were admitted for a period of less than 1 month, however, prolonged admissions were noted, with 11% of patients (n = 8) admitted for a period of more than 1 year. A significant correlation of in-hospital stay was established with age - being inversely proportional to length of stay (r = -0.29); with the infant group having the longest mean duration of in-hospital stay (259 days). The overall discharge rate was 60%. Of the discharged patients, 57% were successfully discharged with tracheostomies in place for continued care in the home environment.

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YU, CHIU HUNG, and 邱虹瑜. "Decision-making for Tracheostomy in Ventilator-Dependent Patient." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/rc9drm.

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碩士
亞洲大學
健康產業管理學系長期照護組
106
When a disease causes multiple organ failure and the function cannot be recovered, it is often necessary to maintain basic respiratory function and sustain life by ventilator-assisted. Because these patients have experienced acute stage and ventilator from the failure of the stage, and in the hospital may be nosocomial infection or other organ complications, resulting in many times the patient is critically ill or near death. The decision to use a respirator is much more difficult than a general medical decision, and caregivers will have a number of important decisions: whether to intubate in an emergency, whether to be cut off from the ventilator, and to choose home care or institutional care after discharge. At present, there are few related topics, such as choosing the factors of respiratory care ward, understanding the needs of patients ' care and the care pressure of caregivers, and discussing the course of the patients who are dependent on the ventilator for the decision-making. Therefore, the study takes the patient care in the respiratory care ward as the main factor to study the choice of gas-cut among the caregivers of ventilator-dependent patients and to understand its dilemma and influence. In this study, a qualitative study was conducted to patients with ventilator-dependent patient caregiver in a hospital with chronic respiratory care in a central region. To develop a semi-structured interview guideline, interview with face-to-face interviews, transcribe the interview content into a verbatim manuscript, and analyze it by qualitative content analysis. There were 10 respondents in this study, including 5 patients with endotracheal tube, 5 patients with tracheostomy caregiver.According to the data analysis, it is found that the decision course of the patients who depend on the respirator will undergo 4 stages, which is differentiated as "prognostic assessment", "message digestion", "Inner impact" and "important decision". In the "Prognostic assessment", different disease diagnoses have different prognosis, during hospitalization, the patient will be regularly carried out breathing training, assessment of the patient's breathing training, will affect the possibility of ventilator detachment ; in the "Digest of Information", to determine the patient's ventilator can not be separated, to the medical staff began to discuss with caregivers to do the tracheostomy, caregivers are affected by the cognitive, including the caregiver on the tracheostomy acceptance, the idea of tracheostomy and myth; In the "inner impact ", the caregiver decides whether to do the tracheostomy, to decide to do the tracheostomy, the caregiver is affected by the behavioral reaction, including the opinion source, the care information and the ethical part;In the "important decision", caregivers decided to accept the reason for the tracheostomy, because the case of ventilator can not be separated, in order to reduce the case of tracheal tube caused by discomfort and sore throat, and the refusal of the cause of tracheostomy diseases including the patient's will, age problems, maintain physical integrity. It is hoped that this study will enable medical staff to understand the choice of caregivers in the process of care, to help them communicate with caregivers, to further develop both acceptable decision-making and care measures, and to improve the quality of holistic care.

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Chvějová, Bronislava. "Role sestry při tracheostomii u dospělých v intenzivní péči - punkční versus chirurgická tracheostomie." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-404084.

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Breathing is one of the basic life functions and for its proper functioning it is necessary to have the airways free and clear. One way to maintain free and open airways is the tracheostomy. Tracheostomy may be performed either by surgical or puncture method. Nursing care and its quality in patients with tracheostomy are important factors that can significantly affect postoperative complications, their course and overall clinical outcome of treatment of patients. Sufficiently qualified, knowledgeable and experienced nurse applies her knowledge in practice with a holistic view of the patient and his needs. The theoretical part of the thesis introduces us to the anatomy of the respiratory tract, the history of tracheostomy, individual methods of tracheostomy - surgical versus puncture and nursing care for adult patients with tracheostomy for intensive care. Methods: In the empirical part, the data obtained on the basis of a quantitative survey in the form of a questionnaire will be evaluated. The sample of respondents will be nurses working in the intensive care department for more than 1 year with experience in nursing care for tracheostomy. Aim of the work: Analysis of nurses awareness about different tracheostomy methods - surgical versus puncture, role of nurse in these methods, their experience...

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Dissertations / Theses on the topic 'Tracheostomy'

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